Contemporary Trends in Primary Retroperitoneal Lymph Node Dissection in Nonseminomatous Germ Cell Tumors.

BACKGROUND: Primary retroperitoneal lymph node dissection (RPLND) provides both curative and staging benefits in marker-negative stage I and IIa-b nonseminomatous germ cell tumors (NSGCTs) of the testis. OBJECTIVE: To examine contemporary, population-based trends in primary RPLND utilization across marker-negative stage I and IIa-b NSGCT. DESIGN, SETTING, AND PARTICIPANTS: Using the Surveillance, Epidemiology, and End Results (SEER) database (2007-2022), we identified adult patients (aged ≥18 yr) with marker-negative stage I, IIa, and IIb NSGCT. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Annual trends, multivariable logistic regression models, and propensity score matching with multivariable competing risks regression models were used. RESULTS AND LIMITATIONS: We identified 6222 patients with marker-negative stage I, 766 with stage IIa, and 649 with stage IIb NSGCT. In stage I, primary RPLND use decreased from 39 patients (16%) in 2007 to 15 patients (2.4%) in 2022. In stage IIa, primary RPLND use decreased from 21 patients (33%) in 2007 to 16 patients (28%) in 2022. In stage IIb, primary RPLND use decreased from 15 patients (52%) to 13 patients (28%) in 2022. In all three stage settings, a more contemporary year of diagnosis independently predicted a lower primary RPLND rate (all p < 0.05). Those rates decreased most sharply in stage I, followed by stage IIb, and stage IIa. Ten-yr cancer-specific mortality rates were low and did not significantly differ between primary RPLND and chemotherapy in stage I or II disease. Limitations include the retrospective design of the SEER database and lack of information on patient comorbidities. CONCLUSIONS: Between 2007 and 2022, primary RPLND use declined substantially across marker-negative stage I and IIa-b NSGCT, raising concern about the long-term sustainability of adequate RPLND volume across centers.