To assess whether extended surveillance with repeated computed tomography (CT) scans for patients with clinical stage IIA (CS IIA; <2 cm abdominal node involvement) and negative markers (Mk-) non-seminomatous germ cell tumours (NSGCTs) can identify those with true CS I. To assess the rate of benign lymph nodes, teratoma, and viable cancer in retroperitoneal lymph node dissection (RPLND) histopathology for patients with CS IIA Mk- NSGCT.
Observational prospective population-based study of patients diagnosed 2008-2019 with CS IIA Mk- NSGCT in the Swedish and Norwegian Testicular Cancer Group (SWENOTECA) registry. Patients were managed with surveillance, with CT scans, and tumour markers every sixth week for a maximum of 18 weeks. Patients with radiological regression were treated as CS I, if progression with chemotherapy, and remaining CS IIA Mk- disease with RPLND. The end-point was the number and percentage of patients down-staged to CS I on surveillance and rate of RPLND histopathology presented as benign, teratoma, or viable cancer.
Overall, 126 patients with CS IIA Mk- NSGCT were included but 41 received therapy upfront. After surveillance for a median (range) of 6 (6-18) weeks, 23/85 (27%) patients were in true CS I and four (5%) progressed. Of the remaining 58 patients with lasting CS IIA Mk- NSGCT, 16 received chemotherapy and 42 underwent RPLND. The RPLND histopathology revealed benign lymph nodes in 11 (26%), teratoma in two (6%), and viable cancer in 29 (70%) patients.
Surveillance with repeated CT scans can identify patients in true CS I, thus avoiding overtreatment. The RPLND histopathology in patients with CS IIA Mk- NSGCT had a high rate of cancer and a low rate of teratoma.
BJU international. 2024 Jan 31 [Epub ahead of print]
Axel Gerdtsson, Helene F S Negaard, Bjarte Almås, Anna Grenabo Bergdahl, Gabriella Cohn-Cedermark, Ingrid Glimelius, Dag Halvorsen, Hege Sagstuen Haugnes, Annika Hedlund, Martin Hellström, Göran Holmberg, Ása Karlsdóttir, Anders Kjellman, Signe Melsen Larsen, Anna Thor, Rolf Wahlqvist, Olof Ståhl, Torgrim Tandstad
Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institutet, Stockholm, Sweden., Department of Oncology, Oslo University Hospital, Oslo, Norway., Department of Urology, Haukeland University Hospital, Bergen, Norway., Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden., Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden., Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden., Department of Urology, St. Olavs University Hospital, Trondheim, Norway., Department of Oncology, University Hospital of North Norway, Tromsø, Norway., Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden., Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden., Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenborg, Sweden., Department of Oncology, Haukeland University Hospital, Bergen, Norway., Department of Urology, Oslo University Hospital, Oslo, Norway., Department of Oncology, Skåne University Hospital, Lund, Sweden., The Cancer Clinic, St. Olavs University Hospital, Trondheim, Norway.