Low-volume nodal metastases detected at retroperitoneal lymphadenectomy for testicular cancer: Pattern and prognostic factors for relapse

Purpose: To determine the incidence, pattern, and predictive factors for re lapse in patients with low-volume nodal metastases (stage pN1) at retroperi toneal lymphadenectomy (RPLND) and identify who may benefit from chemothera py in the adjuvant or primary setting. Patients and Methods: Fifty-four patients with testicular nonseminomatous g erm cell tumor had low-volume retroperitoneal metastases (pathologic stage pN1, 1997 tumor-node-metastasis classification) resected at RPLND, 50 of wh om were managed expectantly without:adjuvant chemotherapy. The dissection w as bilateral:in 12 and was a modified template in 38 patients. Retroperiton eal metastases were limited to microscopic nodal involvement in 14 patients . Follow-up ranged from 1 to 106 months (median, 31.4 months). Results: Eleven patients (22%) suffered a relapse at a median follow-up of 1.8 months (range, 0.6 to 28 months). The most frequent form of recurrence was marker elevation in nine (18%) patients. Persistent marker elevation af ter orchiectomy and before retroperitoneal lymphadenectomy was a significan t independent predictor of relapse (relative risk, 8.0; 95% confidence inte rval, 2.3 to 27.8; P = .001). Four of five (80%) patients with elevated mar kers (alpha-fetoprotein alone in three, alpha-fetoprotein and beta human ch orionic gonadotropin in one) suffered a relapse, compared with seven of 45 (15.6%) patients with normal markers. Conclusion: Clinical stage I and IIA patients with normal markers who have low-volume nodal metastases have a low incidence of relapse and can be mana ged by observation only if compliance can be assured. In contrast, patients with elevated markers before retroperitoneal lymphadenectomy have a high r ate of relapse and should be considered for primary chemotherapy. (C) 2001 by American Society of Clinical Oncology.