Journal of Clinical Oncology, Vol 16, 269-274, Copyright © 1998 by American Society of Clinical Oncology
Validity of predictions of residual retroperitoneal mass histology in nonseminomatous testicular cancer
EW Steyerberg, A Gerl, SD Fossa, DT Sleijfer, R de Wit, WJ Kirkels, N Schmeller, C Clemm, JD Habbema and HJ Keizer
Department of Medical Oncology, University Hospital Groningen, The Netherlands. steyerberg@ckb.fgg.eur.nl
PURPOSE: To validate predictions of the histology (necrosis, mature
teratoma, or cancer) of residual retroperitoneal masses in patients treated
with chemotherapy for metastatic nonseminomatous testicular germ cell
tumor. PATIENTS AND METHODS: We studied 172 testicular cancer patients who
underwent resection while tumor markers were normal. Predictive
characteristics for the residual histology were registered, including the
presence of teratoma elements in the primary tumor, the prechemotherapy
level of tumor markers (alpha-fetaprotein [AFP], human chorionic
gonadotropin [HCG], lactate dehydrogenase [LDH]), the size of the residual
mass, and the percentage of shrinkage in mass diameter. We calculated the
predicted probability of necrosis and the ratio of cancer and mature
teratoma with previously published logistic regression formulas. RESULTS:
The distribution of the residual histology was necrosis in 77 (45%), mature
teratoma in 72 (42%), and cancer in 23 (13%). Necrosis could be well
distinguished from other tissue, with an area under the receiver operating
characteristic (ROC) curve of 82%. No tumor was found in 15 patients with a
predicted probability of necrosis over 90%. The predicted probabilities
corresponded reliably with the observed probabilities (goodness-of-fit
tests, P > .20), although a somewhat higher probability of necrosis was
observed in patients treated with chemotherapy containing etoposide.
Conversely, cancer could not reliably be predicted or adequately
discriminated from mature teratoma. CONCLUSION: The predicted probabilities
of necrosis have adequate reliability and discriminative power. These
predictions may validly support the decision-making process regarding the
need and extent of retroperitoneal lymph node dissection.
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