关于术后早期化疗合并皮质胸腔前淋巴结切除（pcRPLND）标本中具有非畸胎瘤的活性非畸胎瘤性生殖细胞肿瘤患者的治疗策略还没有一致意见。我们分析了监测与不同辅助化疗方案以及pcRPLND时间对肿瘤学结果的影响。我们收集了1990年至2018年期间在13个医疗机构接受顺铂为基础的一线化疗的117名患者的数据。所有患者的pcRPLND标本中均有活性非畸胎瘤细胞。手术在中位数为57天后进行，然后进行监测（n = 64）或辅助化疗（n = 53）。主要终点是无进展生存期（PFS）、癌特异性生存期（CSS）和总生存期（OS）。在控制了国际生殖细胞癌合作组织风险组和在RPLND中发现的活性恶性细胞百分比后，发现无论是接受监测还是辅助化疗的患者在PFS（风险比[Hazard Ratio]，0.72 [95% CI，0.32到1.6]；P = .4）、CSS（HR，0.69；95% CI，0.20到2.39；P = .6）和OS（HR，0.78 [95% CI，0.25到2.44]；P = .7）方面没有差异。根据化疗方案或在一线化疗后进行pcRPLND≤57天与>57天的患者，PFS、CSS或OS方面没有统计学显著差异。残留疾病的存活百分比<10%与≥10%的活性癌细胞相关，前者较长的PFS（HR，3.22 [95% CI，1.29到8]；P = .012）。34（29%）名患者在腹腔后方面出现复发。pcRPLND完全切除且活性细胞<10%的患者在不需进一步治疗的情况下具有较好的预后。完全腹腔后切除似乎比早期进行pcRPLND更重要。

No consensus exists on the management of men with nonseminoma and viable nonteratomatous germ cell tumor in the postchemotherapy retroperitoneal lymph node dissection (pcRPLND) specimen after first-line chemotherapy. We analyzed surveillance versus different adjuvant chemotherapy regimens and the influence of time to pcRPLND on oncologic outcomes.Data on 117 men treated with cisplatin-based first-line chemotherapy between 1990 and 2018 were collected from 13 institutions. All patients had viable nonteratomatous germ cell tumor in the pcRPLND specimen. Surgery was performed after a median of 57 days, followed by either surveillance (n = 64) or adjuvant chemotherapy (n = 53). Primary end points were progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS).After controlling for International Germ Cell Cancer Cooperative Group risk group and percent of viable malignant cells found at RPLND, no difference was observed between men managed with surveillance or adjuvant chemotherapy regarding PFS (hazard ratio [HR], 0.72 [95% CI, 0.32 to 1.6]; P = .4), CSS (HR, 0.69; 95% CI, 0.20 to 2.39; P = .6), and OS (HR, 0.78 [95% CI, 0.25 to 2.44]; P = .7). No statistically significant differences for PFS, CSS, or OS were observed on the basis of chemotherapy regimen or in men treated with pcRPLND ≤57 versus >57 days after first-line chemotherapy. Residual disease with <10% versus ≥10% viable cancer cells were associated with a longer PFS (HR, 3.22 [95% CI, 1.29 to 8]; P = .012). Relapse in the retroperitoneum was observed in 34 (29%) men.Men with a complete resection at pcRPLND and <10% viable cells have favorable outcomes without further treatment. Complete retroperitoneal resection seems more important than early pcRPLND.