Abstract：
BACKGROUND: Testicular cancer is the most common solid malignancy among men aged 15-35. Radical orchiectomy and platinum-based chemotherapy (BEP) are curative in the majority of patients, including advanced, metastatic cases. According to current urooncology guidelines all non-seminoma patients harbouring post-chemotherapy residual masses of ≥ 1 cm should undergo salvage retroperitoneal lymph node dissection (RPLND). However, only 10% of residual tumors contain viable disease.
OBJECTIVE: To assess patient outcomes and complications considering different treatment regimens and clinical characteristics.
METHODS: In a retrospective cross-sectional study patients (n=127) who underwent postchemotherapy RPLND between 2007 and 2023 at our referral center were evaluated. The patients received systemic treatment at various oncology centers. The number of BEP cycles received were occasionally different from standard. Only patients with normal postchemotherapy serum tumor markers and primary testicular or extragonadal germ cell neoplasms were included. Treatment groups were established according to the number of BEP cycles received, and the extent of RPLND (bilateral or modified template). Treatment outcomes and complications were assessed.
RESULTS: Standard 3-4 courses of BEP were received by 100 (78,7%) patients, while 11 (8,7%) patients underwent less, and 16 (12,6%) more courses than standard. On histopathologic evaluation viable germ cell tumor, teratoma, and necrosis/fibrosis was present in 26 (20,5%), 67 (52,7%) and 34 (26,8%) of specimen, respectively. In the 5-6 BEP series subgroup high rate of viable disease (37,5%) was found and significantly more nephrectomies were performed, than other chemotherapy subgroups. Extratesticular GCT, viable disease in residual mass or progression after RPLND indicated lower survival. Mild (Clavien-Dindo I-II) or no postoperative complications were reported in 93,7% of cases.
CONCLUSIONS: The study suggests no significant benefit from exceeding 3-4 courses of BEP. Timely salvage RPLND should be performed in high volume centers for optimal treatment outcomes with acceptable complication rates. Adherence to the Heidenreich criteria is advisable where practical.
OBJECTIVE: To assess patient outcomes and complications considering different treatment regimens and clinical characteristics.
METHODS: In a retrospective cross-sectional study patients (n=127) who underwent postchemotherapy RPLND between 2007 and 2023 at our referral center were evaluated. The patients received systemic treatment at various oncology centers. The number of BEP cycles received were occasionally different from standard. Only patients with normal postchemotherapy serum tumor markers and primary testicular or extragonadal germ cell neoplasms were included. Treatment groups were established according to the number of BEP cycles received, and the extent of RPLND (bilateral or modified template). Treatment outcomes and complications were assessed.
RESULTS: Standard 3-4 courses of BEP were received by 100 (78,7%) patients, while 11 (8,7%) patients underwent less, and 16 (12,6%) more courses than standard. On histopathologic evaluation viable germ cell tumor, teratoma, and necrosis/fibrosis was present in 26 (20,5%), 67 (52,7%) and 34 (26,8%) of specimen, respectively. In the 5-6 BEP series subgroup high rate of viable disease (37,5%) was found and significantly more nephrectomies were performed, than other chemotherapy subgroups. Extratesticular GCT, viable disease in residual mass or progression after RPLND indicated lower survival. Mild (Clavien-Dindo I-II) or no postoperative complications were reported in 93,7% of cases.
CONCLUSIONS: The study suggests no significant benefit from exceeding 3-4 courses of BEP. Timely salvage RPLND should be performed in high volume centers for optimal treatment outcomes with acceptable complication rates. Adherence to the Heidenreich criteria is advisable where practical.
摘要：
背景：睾丸癌是15-35岁男性中最常见的实体恶性肿瘤。在大多数患者中，根治性睾丸切除术和基于铂的化疗（BEP）是治愈的，包括先进的,转移性病例。根据当前的泌尿肿瘤指南，所有化疗后残留肿块≥1cm的非精原细胞瘤患者均应进行腹膜后淋巴结清扫术（RPLND）。然而,只有10%的残留肿瘤含有可行的疾病。
目的：考虑不同的治疗方案和临床特点，评估患者的预后和并发症。
方法：在一项回顾性横断面研究中，对2007年至2023年在我们的转诊中心接受化疗后RPLND的患者（n=127）进行了评估。患者在各个肿瘤中心接受了全身治疗。接受的BEP周期数偶尔与标准不同。仅包括化疗后血清肿瘤标志物正常和原发性睾丸或性腺外生殖细胞肿瘤的患者。根据接受的BEP周期数建立治疗组，和RPLND的范围（双侧或改良模板）。评估治疗结果和并发症。
结果：100例（78,7%）患者接受了标准3-4疗程的BEP，而11名(8.7%)患者接受的治疗较少，比标准课程多16门(12.6%)。在组织病理学评估可行的生殖细胞肿瘤，畸胎瘤,坏死/纤维化出现在26例（20.5%），67(52,7%)和34(26,8%)的样本，分别。在5-6BEP系列亚组中，发现有活力的疾病发生率很高（37,5％），并且进行了更多的肾切除术，比其他化疗亚组。睾丸外GCT,RPLND后残留肿块或进展中的可行疾病表明生存率较低。在93,7％的病例中报告了轻度（Clavien-DindoI-II）或无术后并发症。
结论：该研究表明超过3-4个疗程的BEP没有显著益处。应在高容量中心进行及时抢救RPLND，以获得最佳治疗效果，并发症发生率可接受。在可行的情况下，建议遵守Heidenreich标准。
目的：考虑不同的治疗方案和临床特点，评估患者的预后和并发症。
方法：在一项回顾性横断面研究中，对2007年至2023年在我们的转诊中心接受化疗后RPLND的患者（n=127）进行了评估。患者在各个肿瘤中心接受了全身治疗。接受的BEP周期数偶尔与标准不同。仅包括化疗后血清肿瘤标志物正常和原发性睾丸或性腺外生殖细胞肿瘤的患者。根据接受的BEP周期数建立治疗组，和RPLND的范围（双侧或改良模板）。评估治疗结果和并发症。
结果：100例（78,7%）患者接受了标准3-4疗程的BEP，而11名(8.7%)患者接受的治疗较少，比标准课程多16门(12.6%)。在组织病理学评估可行的生殖细胞肿瘤，畸胎瘤,坏死/纤维化出现在26例（20.5%），67(52,7%)和34(26,8%)的样本，分别。在5-6BEP系列亚组中，发现有活力的疾病发生率很高（37,5％），并且进行了更多的肾切除术，比其他化疗亚组。睾丸外GCT,RPLND后残留肿块或进展中的可行疾病表明生存率较低。在93,7％的病例中报告了轻度（Clavien-DindoI-II）或无术后并发症。
结论：该研究表明超过3-4个疗程的BEP没有显著益处。应在高容量中心进行及时抢救RPLND，以获得最佳治疗效果，并发症发生率可接受。在可行的情况下，建议遵守Heidenreich标准。
