The following is a summary of “Risk Factors for Relapse in Nonseminomatous Testicular Cancer After Postchemotherapy Retroperitoneal Lymph Node Dissection With Viable Residual Cancer,” published in the December 2023 issue of Oncology by Antonelli, et al.

For a study, researchers sought to address the management approach for men with viable nonteratomatous germ cell tumor in the postchemotherapy retroperitoneal lymph node dissection (pcRPLND) specimen following initial chemotherapy. The research analyzed outcomes under surveillance versus various adjuvant chemotherapy regimens, considering the impact of the time to pcRPLND on oncologic results.

Data from 117 men who underwent cisplatin-based first-line chemotherapy between 1990 and 2018 were gathered from 13 institutions. All patients exhibited viable nonteratomatous germ cell tumors in the pcRPLND specimen. Following a median of 57 days, surgery was performed, and patients were subsequently managed with either surveillance (n = 64) or adjuvant chemotherapy (n = 53). The primary endpoints included progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS).

Upon controlling for International Germ Cell Cancer Cooperative Group risk group and the percentage of viable malignant cells found at RPLND, no significant differences were observed between men managed with surveillance or adjuvant chemotherapy in terms of PFS (hazard ratio [HR], 0.72 [95% CI, 0.32 to 1.6]; P = 0.4), CSS (HR, 0.69; 95% CI, 0.20 to 2.39; P = 0.6), and OS (HR, 0.78 [95% CI, 0.25 to 2.44]; P = 0.7). No statistically significant variations in PFS, CSS, or OS were noted based on chemotherapy regimen or in men treated with pcRPLND ≤57 versus >57 days after first-line chemotherapy. Residual disease with <10% versus ≥10% viable cancer cells was associated with longer PFS (HR, 3.22 [95% CI, 1.29 to 8]; P = 0.012). Retroperitoneal relapse occurred in 34 (29%) men.

Men with complete resection at pcRPLND and <10% viable cells demonstrated favorable outcomes without additional treatment. The study suggested that complete retroperitoneal resection may hold greater significance than early pcRPLND.

Source: ascopubs.org/doi/full/10.1200/JCO.23.00443