Primary retroperitoneal lymph node dissection in clinical stage 2a/b non-seminomatous germ cell tumour

Luca Antonelli; Axel Heidenreich; Aditya Bagrodia; Armon Amini; Fady Baky; Nicolas Branger; Walter Cazzaniga; Timothy N Clinton; Siamak Daneshmand; Hooman Djaladat; Scott Eggener; Alireza Ghoreifi; Robert J Hamilton; Matthew Ho; Wade J Sexton; Sebastiano Nazzani; David Nicol; Nicola Nicolai; Kathleen Olson; Pia Paffenholz; James Porter; Zhiyu Qian; Nicholas R Rocco; Anirudh Yerrapragada; Sean P Stroup; Isamu Tachibana; Angelika Terbuch; Nirmish Singla; Clint Cary; Christian D Fankhauser; EAU‐YAU Penile and Testis Cancer Working Group

doi:10.1111/bju.16618

Primary retroperitoneal lymph node dissection in clinical stage 2a/b non-seminomatous germ cell tumour

BJU Int. 2024 Dec 11. doi: 10.1111/bju.16618. Online ahead of print.

Authors

Luca Antonelli^{1

2}, Axel Heidenreich^{3

4}, Aditya Bagrodia^{5

6}, Armon Amini^{5

6}, Fady Baky^{5

6}, Nicolas Branger⁷, Walter Cazzaniga⁸, Timothy N Clinton⁹, Siamak Daneshmand¹⁰, Hooman Djaladat¹⁰, Scott Eggener¹¹, Alireza Ghoreifi¹⁰, Robert J Hamilton¹², Matthew Ho¹¹, Wade J Sexton¹³, Sebastiano Nazzani¹⁴, David Nicol^{8

15}, Nicola Nicolai¹⁴, Kathleen Olson¹⁶, Pia Paffenholz³, James Porter¹⁷, Zhiyu Qian⁹, Nicholas R Rocco¹⁸, Anirudh Yerrapragada¹⁹, Sean P Stroup¹⁸, Isamu Tachibana²⁰, Angelika Terbuch²¹, Nirmish Singla¹⁹, Clint Cary²⁰, Christian D Fankhauser^{1

22}; EAU‐YAU Penile and Testis Cancer Working Group

Affiliations

¹ Department of Urology, Luzerner Kantonsspital, University of Lucerne, Lucerne, Switzerland.
² Department of Urology, Policlinico Umberto I, Sapienza University, Rome, Italy.
³ Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
⁴ Department of Urology, Medical University, Vienna, Austria.
⁵ Department of Urology, Univerity of California, San Diego, CA, USA.
⁶ The University of Texas Southwestern, Dallas, TX, USA.
⁷ Department of Surgical Oncology 2, Institut Paoli-Calmettes, Marseille, France.
⁸ Department of Urology, The Royal Marsden NHS Foundation Trust, London, Sutton, UK.
⁹ Department of Urology, Brigham and Women's Hospital, Boston, MA, USA.
¹⁰ Institute of Urology, Kenneth Norris Jr. Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
¹¹ Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA.
¹² Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
¹³ Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
¹⁴ Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
¹⁵ Institute of Cancer Research, London, UK.
¹⁶ Department of Urology, Mayo Clinic, Scottsdale, AZ, USA.
¹⁷ Department of Urology, University of Washington School of Medicine, Seattle, WA, USA.
¹⁸ Department of Urology, Naval Medical Center, San Diego, CA, USA.
¹⁹ Department of Urology and Oncology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
²⁰ Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
²¹ Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
²² University of Zurich, Zurich, Switzerland.

PMID: 39662898
DOI: 10.1111/bju.16618

Abstract

Objectives: 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.

Materials and methods: 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).

Results: 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.

Conclusions: 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.

Keywords: adjuvant chemotherapy; non‐seminomatous germ cell tumour; primary retroperitoneal lymph node dissection; testis cancer; viable germ cell tumour.