Photo Credit: AII

The following is a summary of “Oncologic outcomes of retroperitoneal lymph node dissection following first-line chemotherapy for metastatic non-seminomatous germ cell tumors” published in the March 2025 issue of Annals of Oncology by Matulewicz et al.

Post-chemotherapy retroperitoneal lymph node dissection (pcRPLND) remains a cornerstone of multimodal treatment for patients with metastatic non-seminomatous germ cell tumors (NSGCT). This study evaluates the pathological and long-term oncologic outcomes following pcRPLND after first-line chemotherapy, with a particular emphasis on the relationship between residual mass size, primary tumor histology, and postoperative pathology. By identifying predictive factors associated with the presence of viable non-teratomatous germ cell tumors, teratoma, or fibrosis/necrosis in the surgical specimen, researchers aim to refine indications for pcRPLND and improve patient selection. A retrospective cohort analysis was conducted on 1,027 patients who underwent pcRPLND at their institution between January 1, 2000, and January 18, 2023. 

The primary outcome assessed was surgical pathology findings, categorized as viable non-teratomatous GCT (with or without teratoma), teratoma only, or fibrosis/necrosis, stratified by residual mass size. Secondary outcomes included 10-year relapse-free survival, disease-specific survival, and overall survival. Among the studied patients, 45% had teratoma, and 4% had viable non-teratomatous GCT in the pcRPLND specimen. With a median follow-up of 5.2 years, retroperitoneal relapse occurred in only one patient, and 26 deaths were attributed to GCT. Notably, the incidence of teratoma in the pcRPLND specimen increased with residual mass size, ranging from approximately 20% for masses <1 cm to nearly 70% for those >5 cm, while the risk of viable non-teratomatous GCT increased from ~2% to ~10%. Larger residual mass sizes were associated with worse 10-year relapse-free and overall survival rates. Multivariable analysis demonstrated that the presence of yolk sac tumor ([OR] 1.86, 95% [CI] 1.35–2.56) and teratoma in the orchiectomy specimen (OR 3.09, 95% CI 2.27–4.23) were independently predictive of teratoma or viable non-teratomatous GCT in pcRPLND pathology. 

These findings suggest that current guideline recommendations based solely on residual mass size may be inadequate and should be reevaluated in the context of primary tumor histology. Given the demonstrated survival benefit and low relapse rates associated with pcRPLND, a more tailored approach integrating histopathologic predictors from orchiectomy specimens could enhance patient selection, optimizing oncologic outcomes and minimizing unnecessary surgical interventions.

Source: annalsofoncology.org/article/S0923-7534(25)00103-6/abstract