Abstract: PD53-02
Sources of Funding: Supported by the Sidney Kimmel Center for Prostate and Urologic Cancers, the Richard Capri Foundation and Support Grant/Core Grant P30 CA008748, T32 CA082088

Introduction

Post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) is rarely performed in patients with advanced germ cell tumors (GCT) and elevated serum tumor markers (STM). Few studies have assessed the therapeutic benefit of PC-RPLND in the setting of elevated STM.

Methods

From 2001 to 2014, 63 patients with elevated STM (alpha-fetoprotein ?15.0 ng/mL and/or human chorionic gonadotropin ?2.2 IU/L) underwent PC- RPLND. We evaluated associations between patient characteristics, histology, and cancer-specific survival (CSS) using descriptive statistics and univariable Cox regression models.

Results

Median age at the time of RPLND was 28 years (IQR 22, 37). Sixteen patients (25%) received two or more courses of chemotherapy prior to RPLND. RP histology revealed viable cancer in 20 patients (32%), teratoma only in 24 (38%), and fibrosis/necrosis only in 19 (30%). Viable cancer was more common among patients treated with second-line chemotherapy than those receiving only first-line chemotherapy (63% vs. 21%, p=0.004) and in those with rising STM at RPLND compared with those with stable/declining STM levels (73% vs. 19%, p=0.001). Concordance rates between retroperitoneal and extra-retroperitoneal sites were 100% for fibrosis, 67% for teratoma, and 43% for viable cancer. Five-year CSS was 83% (95% CI 69-91%) during a median follow-up of 4.5 years for survivors. Persistent STM elevation after RPLND was associated with worse CSS (HR 9.73; 95% CI 2.95-32.07; p<0.001). This study is limited by retrospective data collection and small sample size.

Conclusions

Our findings showed the potential curative benefit of bilateral PC-RPLND and resection of all residual ERP diseases in GCT patients with elevated STM. This suggests that post-chemotherapy surgery should be considered in a subset of patients with low and stable STM levels after first or second-line chemotherapy in order to possibly avoid the long-term toxicity of additional salvage chemotherapy.

Funding

Supported by the Sidney Kimmel Center for Prostate and Urologic Cancers, the Richard Capri Foundation and Support Grant/Core Grant P30 CA008748, T32 CA082088