Surveillance versus retroperitoneal lymph node dissection after induction chemotherapy in patients with seminomatous testicular germ cell tumours metastatic to retroperitoneal lymph nodes: a comparative analysis

Background. In 60–80 % of patients with seminomatous testicular germ cell tumours (STGCT) metastatic to the retroperitoneal lymph nodes (RPLN), residual retroperitoneal masses persist after first-line chemotherapy. The optimal management of such patients – surveillance or retroperitoneal lymph node dissection (RPLND) – remains a matter of debate.

Aim. To compare progression-free survival (PFS) and overall survival (OS) between surveillance and RPLND in patients with STGCT metastatic to RPLN with an incomplete response to induction chemotherapy.

Materials and methods. This retrospective single-centre study included patients with STGCT metastatic to RPLN who received first-line chemotherapy between 2001 and 2025; patients were either kept under surveillance or underwent RPLND. To compare the groups, propensity score matching (PSM) was performed to form a homogeneous subgroup. The primary endpoint was PFS; the secondary endpoint was OS.

Results. The analysis included 74 patients: 51 in the surveillance group and 23 in the RPLND group, of whom 5 patients with histologically confirmed seminoma but marker levels (alpha-fetoprotein ≥20 IU/mL and/or β-subunit of human chorionic gonadotropin >1000 mIU/mL) meeting IGCCCG (International Germ Cell Cancer Collaborative Group) criteria for a non-seminomatous tumour were excluded from the analysis; the main analysis therefore comprised 51 patients under surveillance and 18 who underwent RPLND. The groups were comparable for most baseline characteristics; distant metastases (M1) were significantly more common in the RPLND group (27.8 % vs 7.8 %; p = 0.045). RPLND achieved complete resection (R0) in 94.4 % of cases with a complication rate of 5.6 % (no complications ≥Clavien–Dindo IIIa); viable tumour or teratoma was found in 38.9 % of operated patients. PFS did not differ significantly between the groups: the proportion of progression-free patients was 88.9 % in the RPLND group and 96.1 % in the surveillance group (p = 0.277); median PFS was not reached. No difference was observed in the matched subgroup after PSM either (progression 1/8 vs 0/17; p = 0.29).

Conclusion. In this Russian cohort of STGCT patients with an incomplete response to induction chemotherapy, no significant differences in PFS or OS were found between patients managed with surveillance and those who underwent RPLND. In patients with a favourable prognosis and residual masses, surveillance appears to be a reasonable management strategy.