Presentation Authors: Ryan Werntz*, Craig Labbate, Vignesh Packiam, Scott Eggener, Chicago, IL
Introduction: Retroperitoneal lymph node dissection (RPLND; NCCN category 2a) or chemotherapy (NCCN category 2b) are recommended as first line treatment for clinical stage (CS) IIA NSGCT and are both associated with excellent long-term survival. RPLND cures 70-90% of pN1 patients, eliminating the need for chemotherapy and the potential associated morbidity. Therefore, surveillance is the preferred option after RPLND for pN1 patients. We aimed to determine national practice patterns in the management of CSIIA NSGCT and adherence to NCCN guidelines.
Methods: The National Cancer Data Base (NCDB) was used to identify 1,547 men diagnosed with CSIIA NSGCT with negative serum tumor markers between 2004 and 2016. Trends in the utilization of initial and adjuvant treatment [(chemotherapy only, RPLND only, RPLND with adjuvant chemotherapy (all receiving both chemotherapy and RPLND), and post chemotherapy RPLND)] were analyzed. Opportunities to avoid chemotherapy were analyzed according to final pathologic N stage (pN).
Results: Of the 1,547 men with clinical stage IIA, 18% (273) had RPLND alone, 51% (786) chemotherapy alone, 28% (438) RPLND and adjuvant chemotherapy, and 3% (50) had a post chemotherapy RPLND. In patients with RPLND alone, 32% (88) were pN0, 57% (155) were pN1, 9.5% (26) pN2, and 1.5% (26) pN3. In the RPLND and adjuvant chemotherapy group, 25% (110) were pN0, 59.8% (262) were pN1, 13.2% (58) were pN2, and 1.8% (58) were pN3. There was no association between National Cancer Institute (NCI) status and deliverance of non-guideline based adjuvant chemotherapy (p=0.35)
Conclusions: Induction chemotherapy as first line treatment in clinical stage IIA NSGCT patients was the most common treatment choice despite NCCN guidelines recommending RPLND as the preferred option. In the RPLND and adjuvant chemotherapy group, 85% of patients were pN1 or less yet all received additional chemotherapy, despite surveillance being the preferred NCCN option.