Viable germ cell tumor at postchemotherapy retroperitoneal lymph node dissection - Can we predict patients at risk of disease progression?

BACKGROUND. Patients with viable tumor at time of postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) are at an increased risk of disease progression. The objective of the current study was to determine the clinical variables that predict this adverse outcome. METHODS. Between 1980 and 2003, 236 patients with testicular cancer underwent PC-RPLND, 41 of whom (17%) were found to have viable tumor. The authors retrospectively reviewed the patients' medical records for pertinent clinical and treatment-related outcomes. At a median follow-up of 3.9 years, 18 patients (44%) had developed disease recurrence and 12 patients (29%) had died of disease. RESULTS. The group of patients who developed postoperative disease recurrence had a larger median dimension of the retroperitoneal mass (7.0 cm and 3.5 cm, respectively; P =.03). The use of adjuvant chemotherapy after PC-RPLND was less common in those patients developing postoperative disease recurrence (P =.06). On multivariate analysis, patients classified as being at intermediate or poor risk according to the International Germ Cell Consensus Classification (IGCCC) had a poorer recurrence-free survival (P =.006 and P =.07, respectively). On multivariate analysis, predictors of disease-specific survival (DSS) included an elevated a-fetoprotein (AFP) level before PC-RPLND (P =.003) and postoperative disease recurrence (P =.02). A serum AFP level >5.3 ng/mL before PC-RPLND was found to be predictive of a poorer DSS (P =.0007). CONCLUSIONS. Patients with viable tumor at the time of PC-RPLND are at an increased risk of disease progression. Clinical variables including classification as intermediate or poor IGCCC risk, a preoperative serum AFP level >5.3 ng/mL, and postoperative disease recurrence help to better define those patients who are at risk of future adverse outcomes.