ABSTRACT
Objective@#To explore the clinical outcome of advanced testicular nonseminomatous germ cell cancer patients undergoing post chemotherapy retroperitoneal lymph node dissection (PC-RPLND), and to analyze the relevant prognostic factors of lymph node pathological.@*Methods@#A total of 43 consecutive testicular nonseminomatous germ cell cancer patients underwent PC-RPLND between March 2001 and December 2014 in Department of Urology at Sun Yat-sen University Cancer Center were retrospectively reviewed. The average age of the patients was (29.0±11.5) years (ranging from 12 to 58 years). Before PC-RPLND, 22 patients were classified as phase Ⅱ, while 21 were phase Ⅲ. Primary tumor histology revealed seminomatous elements in 19 cases, embryonal cell carcinoma in 22 cases, yolk sac tumor in 13 cases, chorionic carcinoma in 3 cases, mature teratomatous elements in 11 and immature teratomatous elements in 2 cases. Patients were treated with cisplatin-based chemotherapy after orchectomy and then underwent surgical resection of retroperitoneal lymph nodes.After PC-RPLND, all patients underwent a periodic review including the blood routine, biochemistry routine and computed tomography or ultrasonograph of the chest, the abdomen and the pelvis. The association of pathological data with patient′s clinic features and the correlations between molecular features detected with each other were assessed by the t test, χ2 and Fisher′s exact test. Multivariate logistic regression were used to assess prognostic factors.@*Results@#The median operative time was 278 minutes (ranging from 50 to 715 minutes). Median blood loss was 425 ml (ranging from 50 to 5 000 ml). Eight patients received blood transfusion intra-operatively, 2 patients underwent adjunctive surgical procedures, 4 patients developed ileus and 4 had an ascites chylosus following PC-RPLND, 1 patient had a postoperative hyperthermia and retrograde ejaculation was present in 10 patients. The transverse diameter of the residual tumor in patients ranged from 0.8 to 18.2 cm. Necrosis, teratoma and viable germ cell tumors were found in 15, 17 and 11 of all patients. The median follow-up time was 46 months (ranging from 6 to 169 months). There were 39 patients had no tumor recurrence, 7 patients were found recurrence after PC-RPLND, 5 died of malignant germ cell tumor. The normal serum lactate dehydrogenase (LDH) level before chemotherapy (HR=25.811, 95%CI: 0.678 to 982.624, P=0.017) and relative changes more than 50% in retroperitoneal lymph node size (HR=0.016, 95%CI: 0 to 0.698, P=0.032) were statistically significant prognostic factors of the presence of necrosis.@*Conclusions@#Since most residual masses are not sensitive to chemotherapy, PC-RPLND is still an essential part of the treatment of metastatic testicular nonseminomatous germ cell cancer. Patients with the normal serum LDH level before chemotherapy and a shrinkage of 50% or more in retroperitoneal mass have a considerably chance of having necrosis in the retroperitoneum resection. This may help to refine the selection of candidates for PC-RPLND.
ABSTRACT
Objective To evaluate the efficacy of patients with stage T2 bladder cancer who underwent combined treatment of bladder-preserving surgery and adjuvant intra-arterial chemotherapy.Methods The survival data of bladder cancer paients from January 2000 to December 2014 with stage T2N0M0 were retrospectively analyzed.Thirty-five patients of cT2N0M0 receive combined treatment of bladder-preserving surgery and adjuvant intra-arterial chemotherapy(group A),and 80 patients of pT2N0M0 underwent radical cystectomy (RC) (group B).The pathological diagnosis of all patients was urothelial carcinoma.In group A,there were 33(94.2％) males and 2 (5.8％) females;20 (57.1％) tumor size less than 3 cm and 15 (42.9％) larger than 3 cm;24 (68.6％) with single tumor and 11 (31.4％) with multiple tumors;11 (31.4％) patients with primary tumors and 24 (68.6％) recurrent tumors.In group B,there were 71 (88.7％) males and 9 (11.3％) females;35 (43.8％) tumor size less than 3 cm and 45(56.2％) larger than 3 cm;44 (55.0％) with single tumors and 36 (45.0％) with multiple tumors;22(27.5％) patients with primary tumors and 58 (72.5％) recurrent tumors.Results Groups A and B consisted of 35 and 80 patients and median follow-up time was 68 (13-157)and 67 (4-198)months,respectively.There was no significantly statistical difference in disease-specific survival (DSS) between the two groups(P =0.888),76.5％ for group A and 60.6％ for group B respectively.In group A,26 (74.3％) patients achieved complete response (CR) to intra-arterial chemotherapy.Additionally,amounts of 21 (60.0％) patients preserve their functional bladder successfully and their median follow-up time was 69 (13-134)months.8 patients receive delayed radical cystectomy when suffered tumor recurrence and none of them had lymph node metastases.Of those pathological stage was presented as stage T2 5 cases,T3 2 cases and T4 1 case.Importantly,the 8 patients who receive delayed RC did not confer worse DSS when compared with those underwent immediate RC in group B (P =0.809).Cox proportional hazards model showed that tumor number and CR to intra-arterial chemotherapy was independent prognostic factor for disease-free survival (HR =0.238,P =0.007) and DSS(HR =0.085,P =0.004) respectively.During the period of intra-arterial chemotherapy,we did not observe hematological toxicity of grade Ⅳ and the hematological toxicity of grade Ⅰ-Ⅲ was 9 (25.7％),6 (17.1％) and 4 (11.4％).Conclusions For patients with T2N0M0,combined treatment of bladder-preserving surgery and adjuvant intra-arterial chemotherapy could be a therapy with long-term survival outcome and safety.The therapy could be offered as alternative treatment option for patients who were unsuitable for receiving RC.