Results and outcome of retroperitoneal lymph node dissection for clinical stage I embryonal carcinoma-predominant testis cancer

Purpose: To determine the incidence of metastatic disease and usage of chem otherapy (adjuvant or metastatic) after primary retroperitoneal lymph node dissection (RPLND) in patients with clinical stage (CS) I embryonal carcino ma (EC)-predominant testicular cancer. EC predominance was defined as the p resence of EC at a level greater than that of any other histologic diagonsi s. Patients and Methods: All CS I patients with non-seminomatous germ cell tum ors who underwent RPLND at Indiana University from 1990 to 1995 were review ed retrospectively, Results: Two-year follow-up was available for 292 of 320 patients, EC-predo minant disease was found in 125 (42.8%) of 292. Eighty-five (68.0%) of 125 patients with EC-predominant disease had pathologic stage (PS) I, and 18 (2 1.2%) of this group of 85 relapsed, A significantly lower PS I relapse rare of 3% was found for patients who had non-EC-predominant disease (P < .0001 ). PS II disease was more frequent in patients with EC predominance, as 40 (32.0%) of 125 held retroperitoneal metastases, compared with 26 (15.6%) of 167 patients with a non-EC-predominant histologic diagnosis (P = .0024). C hemotherapy was administered to 48 (38.4%) of the 125 patients with CS I EC -predominant disease after RPLND. This included 25 CS I patients with PS II disease who received adjuvant chemotherapy in addition to 23 patients who subsequently required chemotherapy for relapse after RPLND, Ten (66.6%) of 15 PS II EC-predominant patients were cured by surgery alone. Currently, al l 125 EC-predominant patients are disease-free. Conclusion: patients with CS I EC-predominant disease are at a relatively h igh risk for metastatic disease. (C) 2000 by American Society of Clinical O ncology.