Scholarlink

Background <p>The role of post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) in non-seminomatous germ cell tumour (NSGCT) patients with persistently elevated serum tumour markers remains controversial, although traditional management favours salvage chemotherapy. This study aimed to re-define the surgical and oncologic outcomes of salvage PC-RPLND.</p> Methods <p>We select 107 (2008–2023) consecutive NSGCT patients undergoing PC-RPLND with elevated markers after ≥1 chemotherapy line. Multivariable linear regression models (MLRM), and Cox proportional hazards models recurrence-free survival (RFS) and overall survival (OS) were used.</p> Results <p>Definitive histology revealed viable GCT (47.7%), post-pubertal teratoma (32.7%), fibro-necrotic tissue (FNT) (11.4%), and somatic malignancy (8.4%). After a median follow-up of 45 months, overall 5-year RFS was 54% and OS was 68%. Outcomes varied significantly by histology: post-pubertal teratoma had superior 5-year OS (96%) and RFS (77%), while somatic malignancy and FNT predicted worse RFS (MCRM HRs 23.11 and 28.77, respectively). Larger residual mass size correlated with higher relapse risk and increased probability of somatic malignancy. Advanced stage and increasing chemotherapy lines also associated with poorer outcomes.</p> Conclusions <p>Salvage PC-RPLND for marker-positive NSGCT achieved meaningful survival, particularly for patients with post-pubertal teratoma. These findings support surgery, even as first-line salvage, when teratoma or somatic malignancy is suspected.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Salvage post-chemotherapy retroperitoneal lymph-node dissection: evolving paradigm for marker-positive non-seminomatous germ-cell tumors management

  • 期刊论文

  • 发表日期：

    2026年4月9日

查看全文
  • Sebastiano Nazzani,
  • Carlo Silvani,
  • Cesare Saitta,
  • Alberto Macchi,
  • Tullio Torelli,
  • Silvia Stagni,
  • Gianandrea Gallo,
  • Edoardo Bonacina,
  • Andrea Marmiroli,
  • Valentina Bernasconi,
  • Melanie Claps,
  • Patrizia Giannatempo,
  • Tommaso Cascella,
  • Rodolfo Lanocita,
  • Marco Barella,
  • Biagio Paolini,
  • Maurizio Colecchia,
  • Antonio Tesone,
  • Mario Achille Catanzaro,
  • Davide Biasoni,
  • Emanuele Montanari,
  • Nicola Nicolai

摘要

Background

The role of post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) in non-seminomatous germ cell tumour (NSGCT) patients with persistently elevated serum tumour markers remains controversial, although traditional management favours salvage chemotherapy. This study aimed to re-define the surgical and oncologic outcomes of salvage PC-RPLND.

Methods

We select 107 (2008–2023) consecutive NSGCT patients undergoing PC-RPLND with elevated markers after ≥1 chemotherapy line. Multivariable linear regression models (MLRM), and Cox proportional hazards models recurrence-free survival (RFS) and overall survival (OS) were used.

Results

Definitive histology revealed viable GCT (47.7%), post-pubertal teratoma (32.7%), fibro-necrotic tissue (FNT) (11.4%), and somatic malignancy (8.4%). After a median follow-up of 45 months, overall 5-year RFS was 54% and OS was 68%. Outcomes varied significantly by histology: post-pubertal teratoma had superior 5-year OS (96%) and RFS (77%), while somatic malignancy and FNT predicted worse RFS (MCRM HRs 23.11 and 28.77, respectively). Larger residual mass size correlated with higher relapse risk and increased probability of somatic malignancy. Advanced stage and increasing chemotherapy lines also associated with poorer outcomes.

Conclusions

Salvage PC-RPLND for marker-positive NSGCT achieved meaningful survival, particularly for patients with post-pubertal teratoma. These findings support surgery, even as first-line salvage, when teratoma or somatic malignancy is suspected.