Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, New Jersey.
J Urol. 2022 May;207(5):1057-1066. doi: 10.1097/JU.0000000000002369. Epub 2022 Jan 3.
Retroperitoneal lymph node dissection (RPLND) for men with clinical stage (CS) I or II testicular nonseminomatous germ cell tumor (NSGCT) has both staging and therapeutic implications. We aimed to investigate the impact of lymph node count (LNC) on outcome after primary RPLND for men with CS I or II NSGCT using a nationally representative data set.
A retrospective analysis of men who received a primary RPLND for CS I or II NSGCT was performed using the National Cancer Database. The Kaplan-Meier method was used to determine overall survival (OS) according to LNC. Logistic regression analyses were used to identify factors associated with LNC >20 and factors predictive of lymph node-positive (pN+) disease after primary RPLND.
Of 1,376 men who comprised our analytical cohort, 50.1% and 49.9% had 1-20 lymph nodes (LNs) and >20 LNs removed, respectively. Five-year OS rates were 96.4% and 99.1% for men with 1-20 and >20 LNs resected, respectively (p=0.004). A higher proportion of men with >20 LNs removed were treated at academic centers, had private insurance, presented with higher AJCC (American Joint Committee on Cancer) CS and were more likely to have pN+ disease, compared to those with 1-20 LNs removed. Factors significantly associated with pN+ disease after RPLND include higher AJCC CS and LNC (per 10-count increase).
Higher LNC after primary RPLND significantly increases the likelihood of identifying pN+ disease and is associated with improved OS. Our data support the therapeutic implications of a thoroughly performed RPLND in the primary setting.
对于临床分期（CS）I 或 II 期睾丸非精原细胞瘤生殖细胞肿瘤（NSGCT）的男性，腹膜后淋巴结清扫术（RPLND）具有分期和治疗意义。我们旨在使用全国代表性数据集研究 CS I 或 II 期 NSGCT 男性接受原发性 RPLND 后淋巴结计数（LNC）对结果的影响。
使用国家癌症数据库对接受 CS I 或 II 期 NSGCT 原发性 RPLND 的男性进行回顾性分析。根据 LNC 使用 Kaplan-Meier 法确定总生存率（OS）。使用逻辑回归分析确定与 LNC>20 相关的因素和原发性 RPLND 后预测淋巴结阳性（pN+）疾病的因素。
在我们的分析队列中，有 1376 名男性，分别有 50.1%和 49.9%的男性切除了 1-20 个淋巴结（LNs）和>20 个 LNs。切除 1-20 个和>20 个 LNs 的男性 5 年 OS 率分别为 96.4%和 99.1%（p=0.004）。与切除 1-20 个 LNs 的男性相比，切除>20 个 LNs 的男性更多地在学术中心接受治疗、拥有私人保险、具有更高的 AJCC CS，并且更有可能患有 pN+疾病。与 RPLND 后 pN+疾病显著相关的因素包括更高的 AJCC CS 和 LNC（每增加 10 个计数）。
原发性 RPLND 后较高的 LNC 显著增加了识别 pN+疾病的可能性，并与 OS 改善相关。我们的数据支持在原发性治疗中彻底进行 RPLND 的治疗意义。
