Antonelli Luca, Heidenreich Axel, Bagrodia Aditya, Amini Armon, Baky Fady, Branger Nicolas, Cazzaniga Walter, Clinton Timothy N, Daneshmand Siamak, Djaladat Hooman, Eggener Scott, Ghoreifi Alireza, Hamilton Robert J, Ho Matthew, Sexton Wade J, Nazzani Sebastiano, Nicol David, Nicolai Nicola, Olson Kathleen, Paffenholz Pia, Porter James, Qian Zhiyu, Rocco Nicholas R, Yerrapragada Anirudh, Stroup Sean P, Tachibana Isamu, Terbuch Angelika, Singla Nirmish, Cary Clint, Fankhauser Christian D
Department of Urology, Luzerner Kantonsspital, University of Lucerne, Lucerne, Switzerland.
Department of Urology, Policlinico Umberto I, Sapienza University, Rome, Italy.
BJU Int. 2025 Apr;135(4):621-628. doi: 10.1111/bju.16618. Epub 2024 Dec 11.
To reassess the role of primary retroperitoneal lymph node dissection (RPLND) in patients with marker-negative non-seminomatous germ cell tumour (NSGCT) clinical stage (CS) 2a, to explore results in patients with CS 2b and to evaluate surgical methods, recurrence, and adjuvant chemotherapy indications.
Data from 17 institutions were collected, comprising 305 men who underwent primary RPLND for CS 2 NSGCT. Regression analyses were conducted to predict histology in the RPLND specimen and disease-free survival (DFS).
A larger retroperitoneal lymph node diameter was associated with pure teratoma in the RPLND specimen (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.07; P = 0.03), but no association was observed with DFS. The 5-year DFS rates in marker negative CS 2a and 2b were 79% and 76%. In men with non-teratomatous viable cancer in the RPLND specimen, the 5-year DFS rates for CS 2a and 2b were 95% and 87% with adjuvant chemotherapy, and 67% and 74% without adjuvant chemotherapy. We did not identify an association between the number of adjuvant chemotherapy cycles and DFS.
Our study suggests considering primary RPLND not only in marker-negative CS 2a but also in CS 2b. Further research should determine the efficacy of primary RPLND in men with CS 2c and marker-positive CS 2, as well as which patients may benefit from adjuvant chemotherapy and the optimal cycle number.
重新评估原发性腹膜后淋巴结清扫术（RPLND）在标志物阴性的非精原细胞性生殖细胞肿瘤（NSGCT）临床分期（CS）2a患者中的作用，探讨CS 2b患者的治疗结果，并评估手术方法、复发情况及辅助化疗指征。
收集了17家机构的数据，包括305例因CS 2期NSGCT接受原发性RPLND的男性患者。进行回归分析以预测RPLND标本中的组织学类型和无病生存期（DFS）。
腹膜后淋巴结直径较大与RPLND标本中的纯畸胎瘤相关（比值比[OR] 1.02，95%置信区间[CI] 1.01 - 1.07；P = 0.03），但与DFS无相关性。标志物阴性的CS 2a和2b患者的5年DFS率分别为79%和76%。在RPLND标本中有非畸胎瘤存活癌的男性患者中，CS 2a和2b患者接受辅助化疗的5年DFS率分别为95%和87%，未接受辅助化疗的分别为67%和74%。我们未发现辅助化疗周期数与DFS之间存在关联。
我们的研究表明，不仅对于标志物阴性的CS 2a患者，而且对于CS 2b患者，都应考虑原发性RPLND。进一步的研究应确定原发性RPLND在CS 2c男性患者和标志物阳性的CS 2患者中的疗效，以及哪些患者可能从辅助化疗中获益以及最佳周期数。
