Postchemotherapy retroperitoneal lymph node dissection in patients presenting with very high HCG levels.

Abstract

PURPOSE:

Choriocarcinoma germ cell tumors are rare and usually present with significantly elevated human chorionic gonadotropin (hCG) levels. When curable, it is felt to be largely a result of chemotherapy. We sought to determine the histologic characteristics for those undergoing postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) and compare them with metastatic nonseminomatous germ cell tumor (NSGCT) patients with similarly elevated hCG levels.

METHODS:

We reviewed medical records of men undergoing PC-RPLND between 1988 and 2017 with postorchiectomy, preinduction chemotherapy hCG levels greater than 50,000 mIU/ml. They were stratified by primary tumor histology: Pure choriocarcinoma and mixed NSGCT. Clinical, pathologic, and serologic data were reported and logistic regression was used to assess for predictors of necrosis in the PC-RPLND specimen.

RESULTS:

Our cohort consisted of 108 men. The mixed group (n = 91) had a median hCG of 165,177 mIU/ml, a postchemotherapy node size of 4.7 cm, of whom 19.8% also received salvage chemotherapy prior to RPLND. The pure choriocarcinoma group (n = 17) had a median hCG of 170,267 mIU/ml, a node size of 5.1 cm, of whom 17.6% received salvage chemotherapy. 88.2% of patients with choriocarcinoma had necrosis in the PC-RPLND specimen compared with 29.7% of the mixed NSGCT group (P = <0.0001). Controlling for salvage chemotherapy use, prechemotherapy hCG, node size and marker status, choriocarcinoma patients were 20 fold more likely to have necrosis on RPLND specimen (Odds ratio 20.68 [95% confidence interval 5.279-81.114]).

CONCLUSION:

While PC-RPLND is appropriate in patients with residual masses after chemotherapy, patients with pure choriocarcinoma presenting with significantly elevated hCG levels represent a unique patient population where necrosis is found more often than anticipated.

• Authors: Ryan W Speir, Adam C Calaway, Lawrence H Einhorn, Richard S Foster, Clint Cary
• Journal: Urologic oncology (Urol Oncol) Vol. 38 Issue 8 Pg. 687.e19-687.e23 (08 2020) ISSN: 1873-2496 [Electronic] United States
• PMID: 32448503 (Publication Type: Journal Article, Observational Study)
• Copyright: Published by Elsevier Inc.

Chemical References

• Chorionic Gonadotropin

Topics

• Chorionic Gonadotropin (blood)
• Combined Modality Therapy
• Humans
• Lymph Node Excision
• Lymphatic Metastasis
• Male
• Neoplasms, Germ Cell and Embryonal (blood, drug therapy, pathology, surgery)
• Retroperitoneal Space
• Retrospective Studies
• Testicular Neoplasms (blood, drug therapy, pathology, surgery)