Login to Access Video or Poster Abstract: MP80-15
Sources of Funding: none

Introduction

While retroperitoneal lymph node dissection (RPLND) is traditionally reserved for nonseminomatous germ cell tumors, recent efforts to reduce long-term toxicities of radiation and chemotherapy have turned attention to its application for testicular seminomas. Currently, RPLND is reserved for recurrent or residual masses after chemotherapy for stage 2 testicular seminomas. We aimed to describe the current utilization of RPNLD for testicular seminomas by stage and impact on survival outcomes.

Methods

A national sample of men diagnosed with stage 1A, 1B, 2A, 2B, and 2C testicular seminomas between 1988 and 2013 was evaluated from Surveillance, Epidemiology, and End Results Program registries. Stage-specific utilization of RPLND was determined. Cox proportional hazards models, adjusted for age, race, and radiation therapy, evaluated the impact of RPLND on overall (OS) and cancer-specific survival (CSS). Adjusted models also compared patients receiving only RPLND to those receiving only radiation therapy by stage.

Results

A total of 14807 men (mean age 37, 76% Caucasian, 15% Hispanic) with testicular seminomas were included with low utilization of RPLND for stage 1 disease (1A and 1B; 1.2% overall) and somewhat higher rates for stage 2 disease (10.4% overall). There were no appreciable trends over time. Adjusted models showed no added OS or CSS advantage for RPLND when adjusted for age, race, and radiation therapy among stage 1 (OS HR 1.27 (0.73-2.20), p=0.40) or stage 2 (OS HR 0.96 (0.43-2.17), p=0.93) disease. For the comparison of patients receiving RPLND only to radiation therapy only, adjusted models showed statistically significant worse OS for RPLND for stage 1 disease (HR 2.15 (1.06-4.34), p=0.033) but a non-significant difference for stage 2 disease (HR 1.85 (0.73-4.73), p=0.196). Timing of RPLND relative to chemotherapy was not available.

Conclusions

Among men with testicular seminoma, RPLND was not associated with a survival benefit. Higher risk men undergo RPLND compared to radiation therapy as evidenced by differences in survival. Given that current use of RPLND is largely limited to the post-chemotherapy setting, upcoming trials implementing RPLND as a first-line modality for testicular seminoma will help quantify relative recurrence and survival tradeoffs.

Funding

none