Prediction of relapse after lymph node dissection for germ cell tumours: can salvage chemotherapy be avoided?

Salvage chemotherapy has been used by some oncology centres for patients wi th residual malignant or Immature elements in retroperitoneal lymph node di ssections removed for metastatic non-seminomatous germ cell tumours. Howeve r, surveillance of these patients shows that many are cured by surgery alon e. 118 retroperitoneal lymph node dissections for metastatic non-seminomato us germ cell tumours were reviewed and the morphology seen within them was quantified. 28 of these had immature or malignant elements and had been tre ated by surveillance before administration of further chemotherapy. The pro liferation rate in these cases was assessed by immunochemistry. The prolife ration index and the amount of embryonal carcinoma (EG) were both predictor s of recurrence and therefore the need for further chemotherapy. Patients w ith greater than 25% of EC had an 84% chance of relapse and those with a Ki -67 index of greater than 50% had a 71% chance of relapse. The two tests ha d a positive predictive value of 83% and 71%, respectively. Patients with s uch a high risk of recurrence could be considered for post-operative adjuva nt therapy at this point whilst others would be suitable for a watchful wai ting approach. (C) 2001 Cancer Research campaign.