MP01-20 LONG TERM CLINICAL OUTCOMES FOR PATIENTS WITH NEGATIVE PATHOLOGY (pN0) AT PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION

You have accessJournal of UrologyPenile & Testicular Cancer I (MP01)1 May 2024MP01-20 LONG TERM CLINICAL OUTCOMES FOR PATIENTS WITH NEGATIVE PATHOLOGY (pN0) AT PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION Fady J. Baky, Nicole Liso, Brandon Williams, Jacob Tallman, Deaglan McHugh, Brett Carver, Samuel Funt, Darren Feldman, Joel Sheinfeld, and Richard Matulewicz Fady J. BakyFady J. Baky , Nicole LisoNicole Liso , Brandon WilliamsBrandon Williams , Jacob TallmanJacob Tallman , Deaglan McHughDeaglan McHugh , Brett CarverBrett Carver , Samuel FuntSamuel Funt , Darren FeldmanDarren Feldman , Joel SheinfeldJoel Sheinfeld , and Richard MatulewiczRichard Matulewicz View All Author Informationhttps://doi.org/10.1097/01.JU.0001008660.87408.90.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The retroperitoneum is the initial and primary site of metastasis for most patients with testicular germ cell tumors (GCTs). Following radical orchiectomy, patients with high-risk primary tumors or select patients with low volume retroperitoneal only disease may benefit from primary retroperitoneal lymph node dissection (pRPLND) to definitively stage and treat their cancer. Following pRPLND, adjuvant management strategies are guided by pathologic findings in the retroperitoneum and patients with no cancer (pN0) are assumed to have an excellent prognosis. We describe long-term clinical outcomes among a contemporary cohort of these patients. METHODS: We reviewed our prospectively maintained testicular cancer database for patients who underwent pRPLND from 2000-2023. We excluded those with GCT (pN+) at pRPLND and patients with non-GCT in the primary orchiectomy specimen. All pathology specimen were reviewed by a dedicated genitourinary pathologist. Patient and disease characteristics are reported using descriptive statistics and our primary outcome was 2-year event free survival calculated via the Kaplan-Meier method. Additional outcomes include location and type of recurrence and subsequent treatment outcomes. RESULTS: We identified 350 patients who had pRPLND and were pN0, of whom 281 (80%) were CSI and 69 (20%) were CS IIA. 346 patients had mixed GCT histology (4 with somatic malignant transformation) found at orchiectomy and 4 had pure seminoma. Most patients underwent nerve sparing (84%) pRPLND, and most were performed by a single surgeon (92%) at our institution. Median nodes removed were 50 (IQR: 36, 64). Two-year event free survival was 93% (95% CI: 90, 96) for all patients, 93% (95% CI: 89,95) for patients with CSI disease, and 95% (95% CI: 86, 98) in patients with CSIIA disease. Among 23 patients who experienced relapse, no patients relapsed in the retroperitoneum. Fourteen (61%) relapsed in the lungs. Median time to relapse was 4.6 months. All patients who experienced relapse were effectively treated with chemotherapy; 1 required salvage chemotherapy. There were two deaths, both from non-testis cancer causes. Forty-four patients experienced a 30-day post-operative complication, the majority of which were grade 1-2 (80%) and the remainder were grade 3. CONCLUSIONS: Patients who have no retroperitoneal metastases (pN0) at the time of pRPLND for early stage GCT have a 2-year event free survival between 93-95%. Recurrences are nearly always outside of the retroperitoneum or are detected with elevated STM. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e11 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Fady J. Baky More articles by this author Nicole Liso More articles by this author Brandon Williams More articles by this author Jacob Tallman More articles by this author Deaglan McHugh More articles by this author Brett Carver More articles by this author Samuel Funt More articles by this author Darren Feldman More articles by this author Joel Sheinfeld More articles by this author Richard Matulewicz More articles by this author Expand All Advertisement PDF downloadLoading ...