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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

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Abstract

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.

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Conflict of interest

None of the contributing authors have any conflict of interests associated with the data and results published in this manuscript.

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Authors and Affiliations

  1. Department of Urology, Institut Paoli-Calmettes Cancer Centre, 232, Boulevard Ste. Marguerite, B.P. 156, 13273, Marseille, France

    Cédric Vallier & Jochen Walz

  2. Department of Urology, Hôpital Ste.Anne, Toulon, France

    Pierre-Henri Savoie

  3. Department of Surgery, Institut Paoli-Calmettes Cancer Centre, Marseille, France

    Jean-Robert Delpero

  4. Department of Urology, Jewish Hospital, Montreal, Canada

    Franck Bladou

  5. Department of Oncology, Institut Paoli-Calmettes Cancer Centre, Marseille, France

    Gwenaëlle Gravis

  6. Department of Radiotherapy, Institut Paoli-Calmettes Cancer Centre, Marseille, France

    Naji Salem

  7. Department of Urology, Hôpital Nord, Marseille, France

    Dominique Rossi

Authors
  1. Cédric Vallier
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  2. Pierre-Henri Savoie
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  3. Jean-Robert Delpero
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  4. Franck Bladou
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  5. Gwenaëlle Gravis
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  6. Naji Salem
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  7. Dominique Rossi
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  8. Jochen Walz
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Correspondence to Jochen Walz.

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Vallier, C., Savoie, PH., Delpero, JR. et al. 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. World J Urol 32, 1573–1578 (2014). https://doi.org/10.1007/s00345-014-1240-6

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  • DOI: https://doi.org/10.1007/s00345-014-1240-6

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