External validation of the Heidenreich criteria for patient selection for unilateral or bilateral retroperitoneal lymph node dissection for post-chemotherapy residual masses of testicular cancer

• Published in: World journal of urology 2014-12, Vol.32 (6), p.1573-1578
• Main Authors: Vallier, Cédric, Savoie, Pierre-Henri, Delpero, Jean-Robert, Bladou, Franck, Gravis, Gwenaëlle, Salem, Naji, Rossi, Dominique, Walz, Jochen
• Format: Article
• Language: English
• Subjects: Adult; Antineoplastic Agents - therapeutic use; Cohort Studies; Combined Modality Therapy; Disease-Free Survival; Humans; Lymph Node Excision; Male; Medicine; Medicine & Public Health; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - surgery; Neoplasm, Residual; Neoplasms, Germ Cell and Embryonal - diagnosis; Neoplasms, Germ Cell and Embryonal - drug therapy; Neoplasms, Germ Cell and Embryonal - surgery; Nephrology; Oncology; Original Article; Patient Selection; Reproducibility of Results; Retroperitoneal Space; Testicular Neoplasms - diagnosis; Testicular Neoplasms - drug therapy; Testicular Neoplasms - surgery; Urology
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-014-1240-6

Objective To validate the Heidenreich criteria for patient selection for unilateral retroperitoneal lymph node dissection (RPLND) for residual masses after chemotherapy for nonseminomatous germ cell tumor (NSGCT). Subjects/patients and methods For validation, the data of 59 patients who underwent RPLND for residual masses of NSGCT were used. Of these patients, 23 (39 %) qualified for a modified RPLND, the others had an indication for a bilateral dissection. Results from histopathology after RPLND and follow-up data for relapse inside or outside the zone of the resection template were considered for validation. Results In the study cohort, median age at time of RPLND was 31 years. The 2-year disease-free survival was 90 and 96 % for the bilateral and the unilateral RPLND patients, respectively. Overall, 8 (14 %) relapses were observed after a median follow-up of 54 month. Of these, 6 were outside of the resection field and 2 were in-field. Of the 23 patients with indication for a modified RPLND, 1 patient relapsed in the contralateral testis and 1 inside the modified RPLND template. No relapse was observed outside the modified RPLND field and inside the untouched contralateral RPLND field. The Heidenreich criteria did therefore not misclassify a single patient. Conclusion The Heidenreich criteria for the selection of candidates for unilateral RPLND for residual masses after chemotherapy allow a highly reliable selection of patients. The application of the Heidenreich criteria can help to reduce comorbidity and invasiveness of RPLND.