Unilateral Laparoscopic Retroperitoneal Lymphadenectomy for Clinical Stage I Nonseminomatous Testicular Cancer

1998 ◽  
Vol 12 (6) ◽  
pp. 561-566 ◽  
Author(s):  
G. GIUSTI ◽  
P. BELTRAMI ◽  
C. TALLARIGO ◽  
G. BIANCHI ◽  
G. MOBILIO
Keyword(s):  
Testicular Cancer ◽  
Clinical Stage ◽  
Stage I ◽  
Retroperitoneal Lymphadenectomy

Orchiectomy alone in clinical stage I nonseminomatous testis cancer: a critical appraisal.

1986 ◽  
Vol 4 (1) ◽  
pp. 35-40 ◽  
Author(s):  
G Pizzocaro ◽  
F Zanoni ◽  
A Milani ◽  
R Salvioni ◽  
L Piva ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Clinical Stage ◽  
Stage I ◽  
Testis Cancer ◽  
Retroperitoneal Lymphadenectomy ◽  
Peritumoral Vascular Invasion ◽  
Serum Alpha Fetoprotein ◽  
A Prospective Study ◽  
To Receive ◽  
Disease Free

Sixty-two consecutive patients with clinical stage I nonseminomatous testicular cancer were entered into a prospective study to receive no treatment after orchiectomy until clinical evidence of recurrent disease. Of 59 evaluable cases, 41 (69.5%) remained continuously disease free for a median duration of 30 months (range, 18 to 46 months), and evidence of metastatic disease developed in 18 patients (30.5%) from 2 to 36 months after orchiectomy. The median disease-free interval for relapsing patients was 6 months. Retroperitoneal metastases developed in ten patients; seven patients had pulmonary metastases, and one patient had progressive elevation of the serum alpha-fetoprotein level. Relapses were significantly more frequent in patients with either embryonal carcinoma, infiltrating testicular cancer (pT greater than 1), peritumoral vascular invasion, or in those who underwent transscrotal biopsy. One patient with relapse refused salvage therapy and died. The remaining 17 patients have been rendered disease free with cisplatin combination chemotherapy and/or surgery. However, two patients showed further recurrence, with one in the lung and the other one also in the retroperitoneal nodes. In our opinion, surveillance following orchiectomy will provide useful information in clinical stage I nonseminomatous testicular cancer, but it is a difficult study. For the time being, it should be restricted to specialized centers only. In the meanwhile, retroperitoneal lymphadenectomy remains the standard treatment.

Prognostic factors in clinical stage I nonseminomatous germ cell tumors of the testis: multivariate analysis of a prospective multicenter study. Swedish-Norwegian Testicular Cancer Group.

1990 ◽  
Vol 8 (3) ◽  
pp. 509-518 ◽  
Author(s):  
O Klepp ◽  
A M Olsson ◽  
H Henrikson ◽  
N Aass ◽  
O Dahl ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Testicular Cancer ◽  
Germ Cell ◽  
Primary Tumor ◽  
Vascular Invasion ◽  
Clinical Stage ◽  
Germ Cell Tumors ◽  
Stage I ◽  
Retroperitoneal Lymphadenectomy ◽  
Nonseminomatous Germ Cell Tumors

Between 1981 and 1986, 279 consecutive patients with clinical stage I (CS1) nonseminomatous germ cell tumors (NSGCT) of the testis underwent pathological staging (PS) with retroperitoneal lymphadenectomy (RPLND). Patients with retroperitoneal metastases (PS2) received adjuvant chemotherapy. The median follow-up time after RPLND was 50 months (range, 30 to 90). Clinical and histopathologic features were registered prospectively and analyzed for association with risk of having PS2, relapse despite pathological stage 1 (PS1) or the combined risk of either event, metastatic disease (MET). Seventy-five (26.9%) of the patients had PS2 disease, and 30 (14.7%) of the 204 PS1 patients relapsed, indicating that at least 105 (37.6%) of this CS1 population had subclinical MET at the time of orchiectomy. Four (1.4%) of the 279 CS1 patients died of testicular cancer. Multivariate analyses showed several variables to be significantly associated with outcome for the CS1 patients; vascular invasion in primary tumor and normal preorchiectomy serum alpha-fetoprotein (Pre-AFP) level indicated PS2 disease. If Pre-AFP was excluded from the model, the absence of teratoma or yolk sac elements in the primary tumor became significant predictors of PS2. Vascular invasion, absence of teratoma, and a short interval between orchiectomy and RPLND indicated increased risk of relapse in PS1 patients. Vascular invasion, normal Pre-AFP, absence of teratoma elements, and a short orchiectomy to RPLND interval were predictive of MET. Our results indicate that prognostic factors useful for stratification of CS1 patients with NSGCT to different treatment options may be established.

scholarly journals Prognostic factors for relapse in patients with clinical stage I testicular cancer: protocol for a Danish nationwide cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e033713 ◽  
Author(s):  
Thomas Wagner ◽  
Birgitte Grønkær Toft ◽  
Birte Engvad ◽  
Jakob Lauritsen ◽  
Michael Kreiberg ◽  
...  
Keyword(s):  
Risk Factors ◽  
Testicular Cancer ◽  
Germ Cell ◽  
Clinical Stage ◽  
Cell Cancer ◽  
Germ Cell Cancer ◽  
Stage I ◽  
Testicular Germ Cell ◽  
Testicular Germ Cell Cancer

IntroductionApproximately one-fourth of patients with clinical stage I testicular germ cell cancer will relapse within 5 years of follow-up. Certain histopathological features in the primary tumour have been associated with an increased risk of relapse. The available evidence on the prognostic value of the risk factors, however, is hampered by heterogeneity of the study populations included and variable reporting of the histopathological features. The aim of this study is to identify pathological risk factors for relapse in an unselected large nationwide cohort of patients with stage I disease.Methods and analysisAll incident cases of stage I testicular germ cell cancer diagnosed in Denmark between 2013 and 2018 will be identified using the nationwide prospective Danish Testicular Cancer (DaTeCa) database. Archived microscopic slides from the orchiectomy specimens will be retrieved through linkage to the Danish Pathology Data Bank and reviewed blinded to the clinical outcome. The DaTeCa database includes 960 stage I seminoma patients with expected 185 relapses and 480 patients with stage I non-seminoma with expected 150 relapses. A minimum follow-up period of 3 years of all patients will be ensured. Predefined prognostic variables will be investigated with regard to relapse in univariable and multivariable analysis using the Cox proportional hazards model.Ethics and disseminationThis study protocol has been approved by the Regional Ethics Committee (Region Zealand, Denmark) and the Danish Data Protection Agency. All data will be managed confidentially according to legislation. Study results will be presented at international conferences and published in peer-review journals.

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