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Inicio Actas Urológicas Españolas (English Edition) Lymph node density in retroperitoneal lymph node dissection as a novel marker fo...
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Vol. 45. Issue 1.
Pages 30-38 (January - February 2021)
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Vol. 45. Issue 1.
Pages 30-38 (January - February 2021)
Original article
DOI: 10.1016/j.acuroe.2020.03.005
Lymph node density in retroperitoneal lymph node dissection as a novel marker for predicting recurrence in patients with germ cell testicular cancer: A case-control study and long-term clinical experience of a tertiary referral hospital
La densidad de los ganglios linfáticos en la linfadenectomía retroperitoneal como marcador novel para predecir la recurrencia en pacientes con cáncer testicular de células germinales: estudio de casos y controles y experiencia clínica a largo plazo de un hospital de referencia terciario
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S. Sarikayaa, N. Karsiyakalib,
Corresponding author
nkarsiyakali@hotmail.com

Corresponding author.
, E. Kayaa, B. Topuza, T. Ebiloglua, M. Zora
a Department of Urology, Gulhane Research and Training Hospital, Ankara, Turkey
b Department of Urology, Cukurca State Hospital, Hakkari, Turkey
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Tables (3)
Table 1. Demographic and clinical characteristics of patients according to germ cell cancer subtype.
Table 2. Postoperative management and RPLND characteristics of the patients according to germ cell cancer subtype.
Table 3. Comparisons of patients according to recurrence.
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Abstract
Introduction and objectives

In this retrospective study, we aimed to evaluate lymph node (LN) density in retroperitoneal lymph node dissection (RPLND) to analyze whether residual mass after chemotherapy might behave as predicting factor for recurrence in patients with germ cell testicular cancer (GCTC).

Materials and methods

The data of 185 patients that were operated between 12/2004 and 02/2017 because of GCTC were reviewed retrospectively. LN density was calculated. The patients were compared statistically in terms of demographic features, tumor characteristics, serum tumor marker levels, treatment strategies, and pathological results according to GCTC subtypes. Correlation analysis was performed to determine the parameters related to recurrent disease.

Results

The median follow-up was 79 (31–179) months and the median age of the patients was 23 (16–71). The median tumor size was 4 (1–18) cm. Five (2.7%) patients had metastatic disease at initial diagnosis. Seminoma, non-seminomatous-GCT and mix type-GCTC was detected in 62 (33.5%), 60 (32.4%) and 63 (34.1%) patients, respectively. Following inguinal orchiectomy, 48 (25.9%) patients underwent follow-up, 126 (68.1%) patients underwent chemotherapy and 11 (5.9%) patients underwent radiotherapy. A total of 21 (11.4%) patients underwent post-chemotherapy RPLND. Early and late recurrence was seen in 3 (1.6%) and 2 (1.1%) of the patients, respectively. A mild to moderate, negative, but significant correlation was found between the recurrence and the number of LNs containing metastatic deposits and LN density (r = −0.490, p = 0.024 and r = −0.450, p = 00.041, respectively).

Conclusions

There was a negative correlation between the number of LNs containing metastatic deposits and LN density and recurrent disease.

Keywords:
Germ cell tumors
Non-seminomatous
Retroperitoneal lymph node dissection
Outcome
Seminoma
Testicular cancer
Resumen
Introducción y objetivos

El objetivo de este estudio retrospectivo fue analizar la densidad de los ganglios linfáticos (GL) en la disección de los ganglios linfáticos retroperitoneales (DGLRP) para evaluar la masa residual tras quimioterapia como factor predictivo de recurrencia en pacientes con cáncer testicular de células germinales (CTCG).

Materiales y métodos

Se revisaron retrospectivamente los datos de 185 pacientes operados por CTCG entre dic. 2004 y feb. 2017. Se calculó la densidad de los GL. Los pacientes se compararon estadísticamente en términos de características demográficas, características tumorales, niveles de marcadores tumorales séricos, estrategias de tratamiento y resultados patológicos según los subtipos de CTCG. Se realizó un análisis de correlación para determinar los parámetros relacionados con la enfermedad recurrente.

Resultados

La mediana de seguimiento fue de 79 (31–179) meses y la mediana de edad de los pacientes fue de 23 (16–71). El tamaño medio del tumor fue de 4 (1–18) cm. Cinco (2,7%) pacientes tenían enfermedad metastásica en el momento del diagnóstico inicial. Se detectó seminoma, TCG no seminomatoso y CTCG de tipo mixto en 62 (33,5%), 60 (32,4%) y 63 (34,1%) pacientes, respectivamente. Tras la orquiectomía inguinal, 48 (25,9%) pacientes recibieron seguimiento, 126 (68,1%) pacientes se sometieron a quimioterapia y 11 (5,9%) pacientes recibieron radioterapia. Un total de 21 (11,4%) pacientes se sometieron a DGLRP postquimioterapia. Se observó recurrencia precoz y tardía en 3 (1,6%) y 2 (1,1%) pacientes, respectivamente. Se encontró una correlación negativa leve/moderada, pero significativa, entre la recurrencia y el número de GL con depósitos metastásicos y la densidad de los GL (r = −0.490, p = 0.024 and r = −0.450, p = 00.041, respectivamente).

Conclusiones

Hubo una correlación negativa entre el número de GL con depósitos metastásicos y la densidad de GL con la enfermedad recurrente.

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