Skip to main content
SpringerLink
Log in

Trends of Retroperitoneal Lymphadenectomy Use in Patients with Nonseminomatous Germ Cell Tumor of the Testis: A Population-Based Study

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Retroperitoneal lymphadenectomy (RPLND), chemotherapy, and active surveillance represent treatment options for patients with nonseminomatous germ-cell tumors of the testis (NSGCTT). Our objective was to assess the utilization rate of RPLND in patients with NSGCTT.

Methods

Within the Surveillance, Epidemiology and End Results (SEER) cohort, 4,620 and 1,671 patients with stage I and II NSGCTT were diagnosed between the years 1988 and 2006. Univariable and multivariable logistic regression analyses were performed to test the predictors of RPLND use in respectively patients with stage I and II NSGCTT.

Results

The rate of RPLND according to stage I and II was 27 and 58%, respectively. In patients with stage I disease, the rate of RPLND decreased from 39% in 1988–1995 to 18% in 2004–2006 (P < 0.001), and remained stable for stage II patients (62–56%, P = 0.2). Regional variability existed regarding the rate of RPLND use only in stage I (Utah: 51% vs. Louisiana: 16%). Multivariable analyses performed in stage I NSGCTT revealed that year of diagnosis, SEER registry, and age were significant predictors of RPLND use. However, none of these variables achieved statistical significance within stage II NSGCTT patients.

Conclusions

In patients with stage I NSGCCT, the RPLND utilization rate decreased during the study span. This observation may be ascribed to wider use of surveillance or chemotherapy. No temporal difference was recorded in patients with stage II NSGCCT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. McKiernan JM, Goluboff ET, Liberson GL, et al. Rising risk of testicular cancer by birth cohort in the United States from 1973 to 1995. J Urol. 1999;162:361-3.

    Article  PubMed  CAS  Google Scholar 

  2. Bray F, Richiardi L, Ekbom A, et al. Trends in testicular cancer incidence and mortality in 22 European countries: continuing increases in incidence and declines in mortality. Int J Cancer. 2006;118:3099–111.

    Article  PubMed  CAS  Google Scholar 

  3. de Wit R, Fizazi K. Controversies in the management of clinical stage I testis cancer. J Clin Oncol. 2006;24:5482–92.

    Article  PubMed  Google Scholar 

  4. Albers P, Siener R, Krege S, et al. Randomized phase III trial comparing retroperitoneal lymph node dissection with one course of bleomycin and etoposide plus cisplatin chemotherapy in the adjuvant treatment of clinical stage I Nonseminomatous testicular germ cell tumors: AUO trial AH 01/94 by the German Testicular Cancer Study Group. J Clin Oncol. 2008;26:2966–72.

    Article  PubMed  CAS  Google Scholar 

  5. Surveillance, Epidemiology and End Results (SEER). Surveillance Epidemiology and End Results. National Cancer Institute, 2010. Available at http://seer.cancer.gov/.

  6. Du XL, Fang S, Coker AL, et al. Racial disparity and socioeconomic status in association with survival in older men with local/regional stage prostate carcinoma: findings from a large community-based cohort. Cancer. 2006;106:1276-85.

    Article  PubMed  Google Scholar 

  7. Robert SA, Strombom I, Trentham-Dietz A, et al. Socioeconomic risk factors for breast cancer: distinguishing individual- and community-level effects. Epidemiology. 2004; 15: 442–50.

    Article  PubMed  Google Scholar 

  8. National Comprehensive Cancer Network Guidelines (NCCN). Testicular cancer. Clinical practice guidelines in oncology. 2010. www.nccn.org.

  9. Hotte SJ, Mayhew LA, Jewett M, et al. Management of stage I non-seminomatous testicular cancer: a systematic review and meta-analysis. Clin Oncol (R Coll Radiol).2010;22: 17–26.

    CAS  Google Scholar 

  10. Colls BM. Re: Clinical stage I testis cancer: long-term outcome of patients on surveillance. J Urol. 1999;162:169.

    Article  PubMed  CAS  Google Scholar 

  11. Daugaard G, Petersen PM, Rørth M. Surveillance in stage I testicular cancer. APMIS. 2003;111:76-83; discussion 83–75.

    Article  PubMed  Google Scholar 

  12. Ernst DS, Brasher P, Venner PM, et al. Compliance and outcome of patients with stage 1 non-seminomatous germ cell tumors (NSGCT) managed with surveillance programs in seven Canadian centres. Can J Urol. 2005;12:2575–80.

    PubMed  Google Scholar 

  13. Read G, Stenning SP, Cullen MH, et al. Medical Research Council prospective study of surveillance for stage I testicular teratoma. Medical Research Council Testicular Tumors Working Party. J Clin Oncol. 1992;10:1762-8.

    PubMed  CAS  Google Scholar 

  14. Albers P, Siener R, Krege S, et al. Randomized phase III trial comparing retroperitoneal lymph node dissection with one course of bleomycin and etoposide plus cisplatin chemotherapy in the adjuvant treatment of clinical stage I Nonseminomatous testicular germ cell tumors: AUO trial AH 01/94 by the German Testicular Cancer Study Group. J Clin Oncol. 2008;26:2966–72.

    Article  PubMed  CAS  Google Scholar 

  15. Nguyen CT, Fu AZ, Gilligan TD, et al. Defining the optimal treatment for clinical stage I nonseminomatous germ cell testicular cancer using decision analysis. J Clin Oncol. 2010;28:119–25.

    Article  PubMed  Google Scholar 

  16. Williams SB, McDermott DW, Winston D, et al. Morbidity of open retroperitoneal lymph node dissection for testicular cancer: contemporary perioperative data. BJU Int. 2010;105:918–21.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

Pierre I. Karakiewicz is partially supported by the University of Montreal Health Center Urology Specialists, Fonds de la Recherche en Santé du Quebec, the University of Montreal Department Of Surgery and the University of Montreal Health Center (CHUM) Foundation.

Author information

Authors and Affiliations

  1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center (CHUM), Montreal, QC, Canada

    Maxine Sun BSc, Firas Abdollah MD, Lars Budaüs MD, Daniel Liberman MD, Zhe Tian BSc, Monica Morgan MD, Rupinder Johal MD, Jan Schmitges MD, Paul Perrotte MD & Pierre I. Karakiewicz MD

  2. Department of Urology, Vita Salute San Raffaele University, Milan, Italy

    Firas Abdollah MD & Francesco Montorsi MD

  3. Martini-Clinic, Prostate Cancer Center, Hamburg-Eppendorf, Hamburg, Germany

    Lars Budaüs MD, Jan Schmitges MD & Markus Greafen MD

  4. Department of Urology, University of Montreal Health Center, Montreal, Canada

    Daniel Liberman MD, Monica Morgan MD, Rupinder Johal MD, Paul Perrotte MD & Pierre I. Karakiewicz MD

  5. Department of Urology, Weill Medical College of Cornell University, New York, New York, USA

    Shahrokh F. Shariat MD

Authors
  1. Maxine Sun BSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Firas Abdollah MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lars Budaüs MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel Liberman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhe Tian BSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Monica Morgan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rupinder Johal MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jan Schmitges MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shahrokh F. Shariat MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Francesco Montorsi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Markus Greafen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Paul Perrotte MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Pierre I. Karakiewicz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maxine Sun BSc.

Additional information

Maxine Sun and Firas Abdollah contributed equally to this paper.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sun, M., Abdollah, F., Budaüs, L. et al. Trends of Retroperitoneal Lymphadenectomy Use in Patients with Nonseminomatous Germ Cell Tumor of the Testis: A Population-Based Study. Ann Surg Oncol 18, 2997–3004 (2011). https://doi.org/10.1245/s10434-011-1722-3

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-011-1722-3

Keywords

Search

Navigation