Is primary retroperitoneal lymph node dissection the way forward for patients with testicular seminoma and limited retroperitoneal metastases?
Bibliographic record
Abstract
Testicular cancer represents 1% of adult neoplasms and is the most common solid malignancy in young men. Of men presenting with seminoma, approximately 20% will have clinical stage (CS) II disease, characterized by enlarged retroperitoneal lymph nodes without further metastasis. A further group of men will present with CS I disease but later experience relapse in the retroperitoneal lymph nodes. The standard treatment for many decades in these patients is either radiotherapy (30-36Gy) or chemotherapy (BEPx3, EPx4). Despite high cure rates with these modalities, concerns persist regarding short and long-term treatment-related toxicities. Survivors of testicular cancer treated with chemotherapy or radiotherapy face increased risks of cardiovascular disease (1.5-6-fold) and secondary malignancies (twice as likely for solid cancers and 5 times for leukemia). An alternative approach explored is primary Retroperitoneal Lymph Node Dissection (RPLND). Several institutional series along with 4 single-arm phase II trials have investigated primary RPLND in men with low-volume retroperitoneal metastases. Herein, we review the evidence, strengths and limitations of the current studies and future for primary RPLND for seminoma.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".