Department of Urology, Luzerner Kantonsspital, University of Lucerne, Lucerne, Switzerland.
Department of Urology, Policlinico Umberto I, Sapienza University, Rome, Italy.
J Clin Oncol. 2023 Dec 1;41(34):5296-5305. doi: 10.1200/JCO.23.00443. Epub 2023 Sep 1.
No consensus exists on the management of men with nonseminoma and viable nonteratomatous germ cell tumor in the postchemotherapy retroperitoneal lymph node dissection (pcRPLND) specimen after first-line chemotherapy. We analyzed surveillance versus different adjuvant chemotherapy regimens and the influence of time to pcRPLND on oncologic outcomes.
Data on 117 men treated with cisplatin-based first-line chemotherapy between 1990 and 2018 were collected from 13 institutions. All patients had viable nonteratomatous germ cell tumor in the pcRPLND specimen. Surgery was performed after a median of 57 days, followed by either surveillance (n = 64) or adjuvant chemotherapy (n = 53). Primary end points were progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS).
After controlling for International Germ Cell Cancer Cooperative Group risk group and percent of viable malignant cells found at RPLND, no difference was observed between men managed with surveillance or adjuvant chemotherapy regarding PFS (hazard ratio [HR], 0.72 [95% CI, 0.32 to 1.6]; = .4), CSS (HR, 0.69; 95% CI, 0.20 to 2.39; = .6), and OS (HR, 0.78 [95% CI, 0.25 to 2.44]; = .7). No statistically significant differences for PFS, CSS, or OS were observed on the basis of chemotherapy regimen or in men treated with pcRPLND ≤57 versus >57 days after first-line chemotherapy. Residual disease with <10% versus ≥10% viable cancer cells were associated with a longer PFS (HR, 3.22 [95% CI, 1.29 to 8]; = .012). Relapse in the retroperitoneum was observed in 34 (29%) men.
Men with a complete resection at pcRPLND and <10% viable cells have favorable outcomes without further treatment. Complete retroperitoneal resection seems more important than early pcRPLND.
在一线化疗后行腹膜后淋巴结清扫术（pcRPLND）标本中，对于具有非精原细胞瘤和有活力的非胚胎性生殖细胞肿瘤的男性患者，目前尚无共识来指导其治疗。我们分析了监测与不同辅助化疗方案的效果，并探讨了 pcRPLND 时间对肿瘤学结局的影响。
从 13 家机构收集了 1990 年至 2018 年间接受顺铂为基础的一线化疗的 117 例男性患者的数据。所有患者的 pcRPLND 标本中均存在有活力的非胚胎性生殖细胞肿瘤。中位时间为 57 天后进行手术，随后行监测（n=64）或辅助化疗（n=53）。主要终点为无进展生存期（PFS）、癌症特异性生存期（CSS）和总生存期（OS）。
在控制国际生殖细胞癌合作组（IGCCCG）风险组和 RPLND 时发现的有活力恶性细胞百分比后，与接受监测的男性相比，接受辅助化疗的男性在 PFS（风险比[HR]，0.72[95%置信区间，0.32 至 1.6]；P=0.4）、CSS（HR，0.69；95%置信区间，0.20 至 2.39；P=0.6）和 OS（HR，0.78[95%置信区间，0.25 至 2.44]；P=0.7）方面无显著差异。根据化疗方案或一线化疗后≤57 天与>57 天行 pcRPLND 的男性，其 PFS、CSS 或 OS 也无统计学显著差异。残留疾病中有活力的癌细胞<10%与≥10%与较长的 PFS（HR，3.22[95%置信区间，1.29 至 8]；P=0.012）相关。34 例（29%）男性出现腹膜后复发。
在 pcRPLND 时完全切除且有活力的细胞<10%的男性患者无需进一步治疗即可获得良好的结局。完全的腹膜后切除似乎比早期 pcRPLND 更为重要。
