Journal of Clinical Oncology, Vol 16, 261-268, Copyright © 1998 by American Society of Clinical Oncology
Identification of clinical stage A nonseminomatous testis cancer patients at extremely low risk for metastatic disease: a combined approach using quantitive immunohistochemical, histopathologic, and radiologic assessment
I Leibovitch, RS Foster, KK Kopecky, P Albers, TM Ulbright and JP Donohue
Department of Urology, Indiana University School of Medicine, Indianapolis 46202, USA.
PURPOSE: To evaluate previously determined predictors of metastasis in
low-stage testis cancer in a consecutive group of clinical stage A
patients. PATIENTS AND METHODS: Ninety-one consecutive clinical stage A
nonseminomatous germ cell tumor (NSGCT) patients who underwent primary
nerve-sparing retroperitoneal lymph node dissection (NSRPLND) had
orchiectomy specimens and computed tomographic (CT) scans evaluated blindly
in a quantitative fashion. These scores were then correlated with
pathologic stage using previously determined paradigms. RESULTS: Using
volume of embryonal carcinoma in the orchiectomy specimen, lymph node
diameters in the primary landing zones and MIB-1 staining of the
orchiectomy specimen, 41 patients were classified as low risk for
metastasis. Forty of these 41 had pathologic stage A disease at RPLND.
CONCLUSION: These parameters can identify a low-risk group of patients for
metastasis who can be rationally offered surveillance.
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