Management of Residual Nonretroperitoneal Disease in Postchemotherapy Nonseminomatous Germ-Cell Tumors

Oncologic outcomes of retroperitoneal lymph node dissection following first-line chemotherapy for metastatic non-seminomatous germ-cell tumors

BACKGROUND

Post-chemotherapy retroperitoneal lymph node dissection (pcRPLND) is integral to multimodal treatment of patients with metastatic non-seminomatous germ-cell tumors (NSGCT). We review pathologic and long-term outcomes of pcRPLND following first-line chemotherapy with a focus on residual mass size and primary tumor histology. Our goal was to identify new predictive approaches that can refine surgical indications.

PATIENTS AND METHODS

Patients who underwent pcRPLND for NSGCT at our institution between 1 January 2000 and 18 January 2023 following first-line chemotherapy were included. The primary outcome was surgical pathology categorized as (i) viable non-teratomatous germ-cell tumor (GCT) (with or without teratoma), (ii) teratoma only, or (iii) fibrosis/necrosis stratified by largest residual mass size. Secondary outcomes included 10-year relapse-free survival, disease-specific survival, and overall survival.

RESULTS

Of 1027 eligible patients, 45% had teratoma and 4% had viable non-teratomatous GCT found at pcRPLND. With a median follow-up of 5.2 years, there was one isolated retroperitoneal relapse and 26 GCT-related deaths. As the residual mass size increased, the likelihood of teratoma in the pcRPLND specimen increased from ∼20% (residual masses <1 cm) to ∼70% (>5 cm). The risk of viable non-teratomatous GCT similarly increased from ∼2% up to ∼10%. Ten-year relapse-free and overall survival worsened with increasing mass size. Adjusting for risk group, clinical stage, residual mass size, and lymphovascular invasion at orchiectomy, the presence of yolk sac tumor [odds ratio (OR) 1.86, 95% confidence interval (CI) 1.35-2.56] and teratoma in the orchiectomy specimen (OR 3.09, 95% CI 2.27-4.23) were each independently associated with finding teratoma or viable non-teratomatous GCT at pcRPLND.

CONCLUSIONS

Following first-line chemotherapy, pcRPLND provides effective control of the retroperitoneum with few relapses and GCT-related deaths. Guideline recommendations for or against pcRPLND based on residual mass size alone should be revisited due to the significant association of orchiectomy histology with pcRPLND pathology and the benefits surgical consolidation has on disease control and survival.

Primary embryonal carcinoma of the prostate

Extragonadal germ cell tumors originating in the prostate are extremely rare. Thus far, less than 20 cases were described in the literature. To our knowledge, there are no published cases of primary embryonal carcinoma of the prostate. The present study presents a case of a 24-year-old male with primary prostate embryonal carcinoma. The patient received cisplatin-based chemotherapy. The patient refused a surgical treatment, which resulted in relapse of the disease and death in a short follow-up period. The present case shows that primary embryonal carcinoma may also be found in prostate and indicates the potential importance of timely surgical resection.

Outcomes in Patients With Postchemotherapy Residual Nonretroperitoneal Disease in Nonseminomatous Germ Cell Tumors

This case-control study assesses the association between teratoma in the primary tumor or postchemotherapy resections and survival outcomes.