Serum markers as a prognostic factor in lowvolume nodal metastases

Rabbani and colleagues [36] recently reviewed reports of NSGCT patients who had low-volume nodal metastases at RPLND (pN1) to determine predictive factors for relapse. Of the 50 patients studied, 11 patients relapsed. The most common pattern of relapse arose from marker elevation [36]. Persistent marker elevation before RPLND was a significant predictor of relapse, with a relative risk of 8.0. Patients who have clinical stage I and IIA disease with persistent marker elevation after orchiectomy thus have a high rate of relapse. In this group, primary RPLND may not be adequate, and these patients should be treated with primary chemotherapy followed by consideration of RPLND for residual disease [36].

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