Predicting necrosis in residual mass analysis after retroperitoneal lymph node dissection: a retrospective study
Carregando...
Citações na Scopus
11
Tipo de produção
article
Data de publicação
2012
Editora
BIOMED CENTRAL LTD
Indexadores
Título da Revista
ISSN da Revista
Título do Volume
Autor de Grupo de pesquisa
Editores
Coordenadores
Organizadores
Citação
WORLD JOURNAL OF SURGICAL ONCOLOGY, v.10, article ID 203, 5p, 2012
Resumo
Background: Recent studies have demonstrated that pathological analysis of retroperitoneal residual masses of patients with testicular germ cell tumors revealed findings of necrotic debris or fibrosis in up to 50% of patients. We aimed at pursuing a clinical and pathological review of patients undergoing post chemotherapy retroperitoneal lymph node dissection (PC-RPLND) in order to identify variables that may help predict necrosis in the retroperitoneum. Methods: We performed a retrospective analysis of all patients who underwent PC-RPLND at the University Hospital of the University of Sao Paulo and Cancer Institute of Sao Paulo between January 2005 and September 2011. Clinical and pathological data were obtained and consisted basically of: measures of retroperitoneal masses, histology of the orchiectomy specimen, serum tumor marker and retroperitoneal nodal size before and after chemotherapy. Results: We gathered a total of 32 patients with a mean age of 29.7; pathological analysis in our series demonstrated that 15 (47%) had necrosis in residual retroperitoneal masses, 15 had teratoma (47%) and 2 (6.4%) had viable germ cell tumors (GCT). The mean size of the retroperitoneal mass was 4.94 cm in our sample, without a difference between the groups (P = 0.176). From all studied variables, relative changes in retroperitoneal lymph node size (P = 0.04), the absence of teratoma in the orchiectomy specimen (P = 0.03) and the presence of choriocarcinoma in the testicular analysis after orchiectomy (P = 0.03) were statistically significant predictors of the presence of necrosis. A reduction level of 35% was therefore suggested to be the best cutoff for predicting the absence of tumor in the retroperitoneum with a sensitivity of 73.3% and specificity of 82.4%. Conclusions: Even though retroperitoneal lymph node dissection remains the gold standard for patients with residual masses, those without teratoma in the primary tumor and a shrinkage of 35% or more in retroperitoneal mass have a considerably smaller chance of having viable GCT or teratoma in the retroperitoneum and a surveillance program could be considered.
Palavras-chave
Testicular cancer, Retroperitoneal lymph node dissection, Necrosis
Referências
- Beck SDW, 2009, WORLD J UROL, V27, P485, DOI 10.1007/s00345-009-0452-7
- Carver BS, 2006, J UROLOGY, V176, P100, DOI 10.1016/S0022-5347(06)00508-8
- Dearnaley DP, 2001, BRIT MED J, V322, P1583, DOI 10.1136/bmj.322.7302.1583
- DONOHUE JP, 1987, J UROLOGY, V137, P1176
- El Sayed Salwa, 2004, Int Braz J Urol, V30, P384
- Fizazi K, 2001, J CLIN ONCOL, V19, P2647
- FOSSA SD, 1992, J CLIN ONCOL, V10, P569
- Foster Richard, 2002, Cancer Control, V9, P277
- LORIGAN JG, 1988, AM J ROENTGENOL, V151, P325
- Luz AM, 2010, WORLD J SURG ONCOL, V8, P97
- Motzer RJ, 1998, J UROLOGY, V159, P133, DOI 10.1016/S0022-5347(01)64035-7
- Nicolai N, 2004, J UROLOGY, V171, P172, DOI 10.1097/01.ju.0000101513.64777.f2
- Oldenburg J, 2003, J CLIN ONCOL, V21, P3310, DOI 10.1200/JCO.2003.03.184
- Schmoll HJ, 2004, ANN ONCOL, V15, P1377, DOI 10.1093/annonc/mdh301
- Shayegan B, 2007, BJU INT, V99, P993, DOI 10.1111/j.1464-410X.2007.06740.x
- Sheinfeld Joel, 2002, Semin Urol Oncol, V20, P262, DOI 10.1053/suro.2002.36977
- STEYERBERG EW, 1995, J CLIN ONCOL, V13, P1177
- TAIT D, 1984, BRIT J CANCER, V50, P601, DOI 10.1038/bjc.1984.226