Risk of systemic metastases in clinical stage I nonseminoma germ cell testis tumor managed by retroperitoneal lymph node dissection

Purpose: We assess the risk of systemic recurrence after retroperitoneal ly mph node dissection for clinical stage I nonseminoma germ cell testis tumor based on predominance of embryonal. carcinoma and/or vascular invasion in the orchiectomy specimen. Materials and Methods: A total of 292 cases of clinical stage I nonseminoma germ cell testis tumor treated with retroperitoneal lymph node dissection from 1990 to 1995 were identified from the Indiana University database. A m inimum of 2 years of followup was required for study entry. Review of the w ritten pathological reports classified tumors as embryonal carcinoma predom inant, when it was present at a level greater than any other histology, non predominant, when it was present but not as the main histological subtype, and absent. Vascular invasion was categorized as present or absent. Results: Of the 292 cases 226 (77.4%) were pathological stage I and relapse rate after retroperitoneal lymph node dissection was 10.2%. Vascular invas ion and embryonal carcinoma predominance in the orchiectomy specimen were p redictors of relapse in this group. None of the 35 pathological stage II ca ses treated with adjuvant chemotherapy had relapse, whereas relapse occurre d in 7 of 31 pathological stage II cases (22.6%) not treated with adjuvant chemotherapy. Conclusions: Pathological stage I cases with predominant embryonal carcinom a and/or vascular invasion in the orchiectomy specimen have a higher probab ility of systemic recurrence after retroperitoneal lymph node dissection. D issection alone still has a major therapeutic impact (77%) in patients with clinical stage I, pathological stage II nonseminoma germ cell testis tumor .