BETHESDA, MD USA (UroToday.com) - Dr. Mohammed Haseebuddin and colleagues from Fox Chase Cancer Center presented on the declining rates of retroperitoneal lymph node dissection (RPLND) for stage I non-seminomatous germ cell tumors (NSGCT) using the National Cancer Database.
Per existing best practice guidelines, careful observation with serial imaging (active surveillance) or primary chemotherapy have supplanted primary RPLND for stage I NSGCT. Hypothesizing that rates of primary RPLND have declined over the past decade, their objective was to assess temporal trends in primary treatment for stage I NSGCT and determine factors associated with receipt of RPLND.
15,822 patients with Stage I NSGCT were queried from 1998-2011. 9001 (56.9%), 2937 (18.6%), and 3884 (24.5%) underwent observation, RPLND, and chemotherapy respectively. While rates of observation minimally changed over time (56.3 in 1998 to 55.0% in 2011, p=0.85), a significant decrease in utilization of RPLND (23.0 to 12.4%, p < 0.001) was matched by a significant increase in receipt of primary chemotherapy (20.7 to 32.5%, p < 0.001). Additionally, rates of RPLND declined across all age groups—age < 30 (24.3% to 12.1%, P < 0.0001), age 30-39 (21.6% to 13.8%, p < 0.0001), age 40-49 (23.1% to 11.4%, p < 0.0001), age > 50 (20.0% to 11.7%, p = 0.02).
Following adjustment, stage T2 (OR 0.79 [CI 0.72-0.87]) and T3 (OR 0.33 [CI 0.24-0.96]), and age categories 40-49 years (OR 0.83 [CI 0.72-0.94]) and ≥ 50 years (OR 0.66 [CI 0.52-0.82]) were associated with decreased utilization of RPLND.
In conclusion, the authors report that in hospitals reporting to the NCDB, utilization of primary RPLND for stage I NSGCT has significantly decreased over the last decade, while receipt of primary chemotherapy has increased over the same period. Rates of observation remain unchanged.
Click HERE to read the abstract and view the poster.
Presented by:
Mohammed Haseebuddin, Elizabeth Handorf, Alexander Kutikov, Nikhil Waingankar, Yu-Ning Wong, Elizabeth Plimack, Robert Uzzo, and Marc Smaldone
Fox Chase Cancer Center, Philadelphia, PA USA
Reported by:
Mohammed Haseebuddin, MD* from the 2014 Winter Meeting of the Society of Urologic Oncology (SUO) "Defining Excellence in Urologic Oncology" - December 3 - 5, 2014 - Bethesda, MD USA
*Fox Chase Cancer Center, Philadelphia, PA USA