Nuclear medicine imaging in non-seminomatous germ cell tumors: lessons learned from the past failures

Cancer Imaging

Table 2 Prognosticators of post-chemotherapy retroperitoneal residual mass

Favorable prognosis	Unfavorable prognosis
No teratoma component in the orchiectomy specimen [27] ^{1, 2}	Abnormal tumor markers [53]
Normal pre-chemotherapy AFP and HCG [27]	Multiple FDG-avid residual masses [53]
Elevated pre-chemotherapy LDH [27] ^*3	Post-chemotherapy nodal size [24]
Small residual mass (< 10–20 mm in small transverse diameter) [27] ^*2	Supra-diaphragmatic lymph nodes and/or visceral metastasis [6]
Marked residual mass reduction (> 70–90%) [27]	Prior history of relapse [25]
< 10% residual viable cells in the PC-RPLND specimen [16]	Late-onset relapse (i.e., > 2 years) following chemotherapy [25]

^*1 Predictors of teratoma in post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) specimen includes presence of teratoma and yolk sac tumor in the orchiectomy specimens [11]. Absence of teratoma in the orchiectomy specimen does not exclude the presence of teratoma in PC-RPLND [24, 25]
^*2 Predictors of necrosis in PC-RPLND specimen includes presence of seminomatous and absence of teratomatous elements in the primary tumor, normal pre-chemotherapy beta-hCG and AFP levels, small pre-chemotherapy (cutoff: <2 cm) or post-chemotherapy (cutoff: ≤1 cm) lymph nodes and >50% mass size reduction following chemotherapy [26, 30]
^*3 The International Germ Cell Cancer Collaborative Group prognostic classification also considers elevated LDH levels in the poor prognostic group [9]

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