IDENTIFICATION OF CLINICAL STAGE A NONSEMINOMATOUS TESTIS CANCER-PATIENTS AT EXTREMELY LOW-RISK FOR METASTATIC DISEASE - A COMBINED APPROACH USING QUANTITATIVE IMMUNOHISTOCHEMICAL, HISTOPATHOLOGIC, AND RADIOLOGIC ASSESSMENT

Purpose: To evaluate previously determined predictors of metastasis in low-stage testis cancer in a consecutive group of clinical stage A pa tients. Patients and Methods: Ninety-one consecutive clinical stage A nonseminomatous germ cell tumor (NSGCT) patients who underwent primary nerve-sparing retroperitoneal lymph node dissection (NSRPLND) had orc hiectomy specimens and computed tomographic (CT) scans evaluated blind ly in a quantitative fashion. These scores were then correlated with p athologic stage using previously determined paradigms. Results: Using volume of embryonal carcinoma in the orchiectomy specimen, lymph node diameters in the primary landing zones and MIB-1 staining of the orchi ectomy specimen, 41 patients were classified as low risk for metastasi s. Forty of these 41 had pathologic stage A disease at RPLND. Conclusi on: These parameters can identify a low-risk group of patients for met astasis who can be rationally offered surveillance. (C) 1998 by Americ an Society of Clinical Oncology.