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Retroperitoneal lymph node dissection for testicular seminomas: population-based practice and survival outcomes

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Abstract

Purpose

While retroperitoneal lymph node dissection (RPLND) is traditionally reserved for nonseminomatous germ cell tumors, recent efforts to reduce long-term toxicities of radiation and chemotherapy have turned attention to its application for testicular seminomas. Currently, RPLND is reserved for the post-chemotherapy for stage II testicular seminomas; we aimed to describe current utilization of RPNLD for testicular seminomas by stage and implications for survival.

Methods

A national sample of men diagnosed with stage IA/IB/IS/IIA/IIB/IIC testicular seminoma (1988–2013) was evaluated from SEER Program registries. Stage-specific utilization of RPLND was determined. Cox proportional hazards models, adjusted for age, race, and radiotherapy, evaluated overall (OS) and cancer-specific survival (CSS) for the RPLND cohort. Adjusted models assessed predictors of RPLND.

Results

A total of 17,681 men (mean age 38.1 years) with testicular seminoma were included with low utilization of RPLND for stage I disease (1.3% overall) and higher rates for stage II disease (10.6% overall). There were no appreciable trends over time. Patients receiving RPLND did not appear to have worse OS or CSS on adjusted stage-by-stage analysis. Higher stage disease (IIA-IIC) was associated with greater need for RPLND while radiotherapy was associated with decreased use [OR 0.40 (0.32–0.51), p < 0.001].

Conclusions

Utilization of RPLND for testicular seminomas in the post-chemotherapy setting has remained stable over a 25-year period. Patients undergoing RPLND are a higher risk cohort but stage-by-stage survival outcomes appeared comparable to men not undergoing RPLND. Upcoming trials implementing RPLND as a first-line modality for testicular seminoma or isolated retroperitoneal relapse will help better quantify relative recurrence and survival.

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Authors and Affiliations

  1. The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/Marburg 134, Baltimore, MD, 21287, USA

    Hiten D. Patel, Gregory A. Joice, Zeyad R. Schwen, Alice Semerjian, Ridwan Alam, Arnav Srivastava, Mohamad E. Allaf & Phillip M. Pierorazio

Authors
  1. Hiten D. Patel
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  2. Gregory A. Joice
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  3. Zeyad R. Schwen
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  4. Alice Semerjian
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  5. Ridwan Alam
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  6. Arnav Srivastava
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  7. Mohamad E. Allaf
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  8. Phillip M. Pierorazio
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Contributions

HDP project development, data management, data analysis, manuscript writing/editing. GAJ: project development, manuscript editing. ZRS: project development, manuscript editing. AS: project development, manuscript editing, other (supervision). RA: project development, data management, manuscript editing. AS: project development, data management, manuscript editing. MEA: project development, manuscript editing, other (supervision). PMP: project development, manuscript editing, other (supervision).

Corresponding author

Correspondence to Hiten D. Patel.

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There are no financial conflicts of interest.

Research involving human participants and/or animals

The study was approved by the institutional review board for retrospective, de-identified analysis. No animals were involved.

Informed consent

The institutional review board waived informed consent given the retrospective, de-identified nature of the study using SEER data.

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Patel, H.D., Joice, G.A., Schwen, Z.R. et al. Retroperitoneal lymph node dissection for testicular seminomas: population-based practice and survival outcomes. World J Urol 36, 73–78 (2018). https://doi.org/10.1007/s00345-017-2099-0

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  • DOI: https://doi.org/10.1007/s00345-017-2099-0

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