ЗАБРЮШИННАЯ ЛИМФАДЕНЭКТОМИЯ ПОСЛЕ ИНДУКЦИОННОЙ ХИМИОТЕРАПИИ ПРИ ДИССЕМИНИРОВАННЫХ НЕСЕМИНОМНЫХ ГЕРМИНОГЕННЫХ ОПУХОЛЯХ ЯИЧКА
https://doi.org/10.17650/1726-9776-2010-6-1-52-58
Аннотация
Objective: to evaluate the outcome of retroperitoneal lymph node dissection (RLND) in disseminated testicular non-seminoma patients with residual metastases after induction chemotherapy. Material and methods. The RLND performed in 1983 to 2007 were analyzed in 367 testicular non-seminoma patients with residual retroperitoneal masses after ineffective induction chemotherapy. The median age was 26.06.9 years. Orchidectomy was performed in all patients. Category N1 was regarded in 12 (3.3%) patients, N2 in 79 (21.5%), N3 in 238 (64.9%), Nx in 38 (10.4%). Distant metastases were present in 133 (36.2%) cases. The baseline tumor marker level was elevated in 328 (89.4%) patients (S1 in 169 (46.0%), S2 in 108 (29.4%), S3 in 51 (13.9%), Sx in 39 (10.6%)). According to the IGCCCG prognostic model, 149 (40.6%) patients were classified as good prognostic group, 100 (27.2%) as moderate, 77 (21.0%) as poor ones; the prognostic group was not defined in 41 (11.2%) cases who had started treatment at another facility due to data unavailability. After orchifuniculectomy, all patients received induction cisplatin-based chemotherapy which resulted in tumor shrinkage <50% in 70 (19.1%), 51-90% in 166 (45.2%), and >90% - in 29 (7.9%) cases. The response was not properly assessed in 102 (27.8%) cases. CT scan revealed residual retroperitoneal masses after chemotherapy in all patients (<2 cm - 52 (14.2%), 2-5 cm - 166 (45.2%), >5 cm - 149 (40.6%)). The tumor markers level remained elevated following chemotherapy in 70 (19.1%) cases. All patients underwent RLND (complete in 295 (80.4%) cases). Radical RLND demanded resection of adjacent organs in 22 (5.9%) cases. Extraretroperitoneal metastases were removed simultaneously with retroperitoneal tumor in 22 (5.9%) patients. Postoperative chemotherapy was administered in 100 (27.2%) cases. The median followup was 82.1 (3-188) months. Results. Complications developed in 31 (8.5%) of the 367 of patients. Mortality rate was 0.6% (2/367 cases). Resection of the adjacent organs did not influence mortality rates. Histology revealed necrosis in 149 (40.6%), teratoma in 141 (38.4%), cancer in 77 (21.0%) specimens. The significant predictive factors for necrosis were normal levels of markers following chemotherapy, a residual mass size of < 2 cm, tumor shrinkage >90% (the accuracy of the logistic model for probability of necrosis in the removed specimen was 78%). Discordant pathologic findings between the retroperitoneum and other metastatic sites were in 3 (13.6%) of 22 cases. Ten-year overall, specific and progression- free survival (PFS) was 92.1, 92.4, and 46%, respectively. A poor and moderate prognostic group IGCCCG (p<0.0001), incomplete resection of residual mass (p<0.0001) and presence of cancer in the removed specimens (p<0.0001), initial retroperitoneal masses >5 cm (p=0.042), presence of extraretroperitoneal metastases (p<0.0001), category S>S1 (p<0.0001), positive marker levels after induction (p=0.048) were found to have an adverse impact on PFS. Removal of residual extraretroperitoneal metastases after chemotherapy improved progression-free survival (p=0.022). Postoperative chemotherapy did not influence survival significantly. Multivariate analysis confirmed the predictive value of the radicality of RLND (p=0.036). Conclusion. Radical RLND improves the results of combined treatment in metastatic testicular non-seminoma. It is expedient to make resection of the adjacent organs and extraretroperitoneal metastasectomy in order to achieve a complete removal of residual masses. Whether adjuvant chemotherapy should be used in cases with cancer in residual mass is under discussion.
Об авторах
В. Б. Матвеев
Отделение урологии ГУ РОНЦ им. Н.Н. Блохина РАМН, Москва
Россия
Россия
М. И. Волкова
Отделение урологии ГУ РОНЦ им. Н.Н. Блохина РАМН, Москва
Россия
Россия
К. М. Фигурин
Отделение урологии ГУ РОНЦ им. Н.Н. Блохина РАМН, Москва
Россия
Россия
В. А. Черняев
Отделение урологии ГУ РОНЦ им. Н.Н. Блохина РАМН, Москва
Россия
Россия
А. В. Митин
Отделение урологии ГУ РОНЦ им. Н.Н. Блохина РАМН, Москва
Россия
Россия
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Рецензия
Для цитирования:
Матвеев В.Б., Волкова М.И., Фигурин К.М., Черняев В.А., Митин А.В. ЗАБРЮШИННАЯ ЛИМФАДЕНЭКТОМИЯ ПОСЛЕ ИНДУКЦИОННОЙ ХИМИОТЕРАПИИ ПРИ ДИССЕМИНИРОВАННЫХ НЕСЕМИНОМНЫХ ГЕРМИНОГЕННЫХ ОПУХОЛЯХ ЯИЧКА. Онкоурология. 2010;6(1):52-58. https://doi.org/10.17650/1726-9776-2010-6-1-52-58
For citation:
Matveev V.B., Figurin K.M., Volkova M.I., Chernyaev V.A., Mitin A.V. RETROPERITONEAL LYMPH NODE DISSECTION AFTER INDUCTION CHEMOTHERAPY IN METASTATIC TESTICULAR NON-SEMINOMA. Cancer Urology. 2010;6(1):52-58. (In Russ.) https://doi.org/10.17650/1726-9776-2010-6-1-52-58
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