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World Journal of Surgical Oncology

, 10:203

First Online: 28 September 2012Received: 29 November 2011Accepted: 31 August 2012


BackgroundRecent studies have demonstrated that pathological analysis of retroperitoneal residual masses of patients with testicular germ cell tumors revealed findings of necrotic debris or fibrosis in up to 50% of patients. We aimed at pursuing a clinical and pathological review of patients undergoing post chemotherapy retroperitoneal lymph node dissection PC-RPLND in order to identify variables that may help predict necrosis in the retroperitoneum.

MethodsWe performed a retrospective analysis of all patients who underwent PC-RPLND at the University Hospital of the University of São Paulo and Cancer Institute of Sao Paulo between January 2005 and September 2011. Clinical and pathological data were obtained and consisted basically of: measures of retroperitoneal masses, histology of the orchiectomy specimen, serum tumor marker and retroperitoneal nodal size before and after chemotherapy.

ResultsWe gathered a total of 32 patients with a mean age of 29.7; pathological analysis in our series demonstrated that 15 47% had necrosis in residual retroperitoneal masses, 15 had teratoma 47% and 2 6.4% had viable germ cell tumors GCT. The mean size of the retroperitoneal mass was 4.94 cm in our sample, without a difference between the groups P = 0.176. From all studied variables, relative changes in retroperitoneal lymph node size P = 0.04, the absence of teratoma in the orchiectomy specimen P = 0.03 and the presence of choriocarcinoma in the testicular analysis after orchiectomy P = 0.03 were statistically significant predictors of the presence of necrosis. A reduction level of 35% was therefore suggested to be the best cutoff for predicting the absence of tumor in the retroperitoneum with a sensitivity of 73.3% and specificity of 82.4%.

ConclusionsEven though retroperitoneal lymph node dissection remains the gold standard for patients with residual masses, those without teratoma in the primary tumor and a shrinkage of 35% or more in retroperitoneal mass have a considerably smaller chance of having viable GCT or teratoma in the retroperitoneum and a surveillance program could be considered.

KeywordsTesticular cancer Retroperitoneal lymph node dissection Necrosis Teratoma AbbreviationsAFPAlphs-fetoprotein

AUCArea under the curve

CTComputed tomography

GCTGerm cell tumor

hCGHuman chorionic gonadotropin

LDHLactate dehydrogenase

LVILymph vascular invasion

NSGCTNonseminomatous germ cell tumor

PC-RPLNDPost chemotherapy retroperitoneal lymph node dissection

ROCReceiver operating characteristic

RPLNDRetroperitoneal lymph node dissection.

Electronic supplementary materialThe online version of this article doi:10.1186-1477-7819-10-203 contains supplementary material, which is available to authorized users.

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Autor: Eduardo de Paula Miranda - Daniel Kanda Abe - Adriano João Nesrallah - Sabrina Thalita dos Reis - Alexandre Crippa - Mi


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