Department of Urology, Heinrich-Heine-University, Duesseldorf, Germany
Peter Albers , Alessandro Nini , Andreas Hiester , Christian Winter , Achim Lusch , Anja Lorch
Background: Although the use of PC-RPLND in testis cancer patients in the salvage setting has been reported, existing data characterizing histologic findings are poor. Methods: 179 PC-RPLNDs after salvage chemotherapy were selected from a prospective database of 504 RTRs (434 patients, 2003-2018). Uni- and multivariate analyses were used to assess the impact of preoperative positive markers, residual diameter, and type of salvage chemotherapy (either conventional salvage [CTX] or high dose chemotherapy [HDC]) on vital cancer histology (including teratoma with malignant transformation) at PC-RPLND. Results: Median age was 37 years (IQR 30-45). 11.5% of patients underwent thoraco-abdominal PC-RPLND and adjunctive surgeries were needed in 41.7%. Clavien-Dindo > II complications were registered in 5% of cases. After stratification for CTX and HDC, AFP only, β-HCG only, and both markers elevated were seen in 27.8%, 7.8%, and 2.2%, and 33%, 18.2% and 5.7% of patients, respectively. Overall, necrosis, postpubertal teratoma, and vital cancer were found in 30%, 29%, and 42%, respectively. Vital cancer was found in residual tumor sizes of < 2 cm and ≥ 2 cm in 41.2% and 32.9%, respectively. After stratification for CTX and HDC, patients after CTX had lower rates of necrosis (26% vs. 34%, p = 0.2) but not of vital cancer (42% vs. 42%, p = 0.9). The predictors of vital cancer were represented by the presence of AFP elevation only (OR 4.7, p = 0.001) and both markers elevated (OR 8.6, p = 0.02). Conclusions: In the salvage setting, the rate of vital cancer in residual tumor is three times higher as compared to the first-line setting. Presence of AFP elevation only or both markers elevated represent predictors of vital cancer. PC-RPLND has to be performed after salvage chemotherapy independent of the residual tumor diameter.
UVA | MVA | |||
---|---|---|---|---|
OR (CI 95%) | p-value | OR (CI 95%) | p-value | |
Preoperative marker status | ||||
No | Ref. | - | Ref. | - |
AFP | 4.4 (1.9 – 10.3) | < 0.0001 | 4.7 (1.9 -11.6) | 0.001 |
βHCG | 1.2 (0.4 -3.7) | 0.7 | 1.8 (0.5 – 5.8) | 0.3 |
Both | 7.1 (1.2 – 41) | 0.03 | 8.6 (1.3 – 54) | 0.02 |
Biggest diameter | 1 (0.9 - 1.0) | 0.9 | 1 (0.9 - 1.1) | 0.6 |
HDC vs. CHT | 1.5 (0.8 - 3) | 0.2 | 0.6 (0.3 – 1.4) | 0.3 |
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