PREDICTIVE PARAMETERS IN BIOLOGIC ASSESSMENT OF LOW-STAGE RETROPERITONEAL LYMPH-NODE DISSECTION

In all, 30% of patients felt to have clinical stage A nonseminomatous testis cancer in fact have pathologic stage B disease. Although patien ts with clinical stage A nonseminoma currently enjoy a very high chang e for cure, a better assignment of therapy at diagnosis could lead to an overall decrease in the morbidity of treatment. This study analyzed orchiectomy specimens from 102 patients with clinical stage A nonsemi nomatous testis cancer, all of whom underwent pathologic staging via r etroperitoneal lymph-node dissection (RPLND). Various parameters of th e orchiectomy specimen were analyzed to determine wheter or not clinic al staging could be improved on the basis of these factors. Statistica l analysis resulted in the following model. If the orchiectomy-specime n consisted of 100% embryonal carcinoma the patient was classified as being at high risk for retroperitoneal metastasis. In the absence of t his finding the aneuploid cell line as determined by flow cytometry wa s considered. If the percentage of aneuploid cells in the S phase was less than 29% the patient was felt to be at low risk for retroperitone al metastasis. If this percentage was greater than 29% the patient was classified as being at high risk. Using this paradigm, 77% of patholo gic stage A patients and 91% of pathologic stage B patients were corre ctly classified. The test efficiency was 82%. This pilot study resulte d in an interesting model that should be tested prospectively in conse cutive patients to determine whether it is clinically useful.