Outcomes of Retroperitoneal Lymph Node Dissection for Non-Seminomatous Germ Cell Tumors

What is it about?

This study compares the outcomes and treatment burden of primary retroperitoneal lymph node dissection (pRPLND) alone versus pRPLND + adjuvant chemotherapy (AC) in patients with pathological stage II (PSII) non-seminomatous germ cell tumours (NSGCT). The primary outcome was relapse-free survival (RFS), and secondary outcomes included disease-specific survival (DSS), burden of relapse treatment, and factors associated with relapse. A total of 109 PSII patients were included in the study, with 96 patients treated with pRPLND alone and 13 treated with pRPLND + AC. The 5-year RFS was 72% for the pRPLND-only group vs 92% for the pRPLND + AC group, and the 5-year DSS was similar at 98% in both groups. Despite a higher relapse rate in the pRPLND-only group, the cumulative post-RPLND treatment burden was less overall. The study concludes that the majority of patients with PSII NSGCT treated with pRPLND alone do not experience a recurrence or require chemotherapy, and AC may constitute overtreatment for most patients with PSII NSGCT treated with pRPLND.

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Why is it important?

The study comparing primary retroperitoneal lymph node dissection (pRPLND) alone versus pRPLND + adjuvant chemotherapy (AC) in patients with pathological stage II (PSII) non-seminomatous germ cell tumours (NSGCT) is important because it provides evidence that supports avoiding AC and suggests that it may constitute overtreatment. The study found that the majority of patients treated with pRPLND alone did not experience a recurrence, and while the 5-year relapse rate was higher when AC was omitted, the total treatment burden was less, and the 5-year disease-specific survival (DSS) was similar. This is crucial as it helps to inform treatment decisions and may reduce unnecessary chemotherapy and its associated side effects. Key Takeaways: 1. Most patients with PSII NSGCT treated with pRPLND alone do not experience a recurrence or require systemic therapy. 2. Despite a lower relapse risk when AC is given, no difference in survival was seen, but a higher chemotherapy burden was entertained. 3. The study supports the preference for avoiding AC and provides evidence that it may constitute overtreatment.