CLINICAL STAGE-B NONSEMINOMATOUS GERM-CELL TESTIS CANCER - THE INDIANA-UNIVERSITY EXPERIENCE (1965-1989) USING ROUTINE PRIMARY RETROPERITONEAL LYMPH-NODE DISSECTION

Between 1965 and 1989, 1180 patients at Indiana University, U.S.A., un derwent retroperitoneal lymph node dissection (RPLND) for non-seminoma tous germ cell (NSGC) testis cancer of whom 638 cases had primary RPLN D. A subset of 174 cases were considered clinical stage B (or II) befo re surgery (retroperitoneal nodal metastases by clinical staging). Sur gery revealed that 23%(n = 41) had pathological stage A disease (no ca ncerous nodes). This error rate in clinical staging has decreased some what with improved techniques, but remains approximately 20% over the last decade. The relapse rate in pathological stage A (n = 41) was 5% (n = 2), both of whom were cured by chemotherapy. The relapse rate in pathological stage B without postoperative adjuvant treatment (n = 54) was 35% (n = 19); 2 patients died. This indicates that 65% of patholo gical stage B cases were cured by RPLND alone. From 1979 to 1989, the 140 pathological stage B cases participated in a randomised prospectiv e trial of post-RPLND adjuvant chemotherapy versus no postoperative tr eatment. Forty two per cent (n = 59) received postoperative platinum-b ased therapy (two cycles), and there has been no relapse after RPLND f or stage B disease. While advances in chemotherapy for NSGC testis can cer have led to its application by several study groups to clinical st age B (or II) testis cancer (with surgery reserved only for those in p artial remission), the equivalent cure rate with RPLND surgery with ch emotherapy rescue reserved for those who relapse appears to have both cost and risk-benefit advantages.