Open Access

ARTICLE

External validation of the heidenreich criteria for patients with post-chemotherapy residual masses of non-seminomatous germ cell tumor

Francesco Claps^1,2,*, Miguel Ramírez-Backhaus¹, Álvaro Gómez-Ferrer¹, Juan Manuel Mascarós¹, Argimiro Collado Serra¹, Augusto Wong¹, Ana Calatrava Fons³, Miguel Ángel Climent⁴, Antonio Amodeo², Angelo Porreca⁵, Jose Rubio-Briones^1,6

1 Department of Urology, Valencian Oncology Institute Foundation, FIVO, Valencia, 46009, Spain
2 Oncological Urology, Veneto Institute of Oncology—IRCCS, Padua, 35128, Italy
3 Department of Pathology, Valencian Oncology Institute Foundation, FIVO, Valencia, 46009, Spain
4 Department of Medical Oncology, Valencian Oncology Institute Foundation, FIVO, Valencia, 46009, Spain
5 Department of Urology, Humanitas Gavazzeni—Humanitas University, Bergamo, 24125, Italy
6 Urological Clinic, Hospital “VITHAS” 9 de Octubre, Valencia, 46015, Spain

* Corresponding Author: Francesco Claps. Email:

Canadian Journal of Urology 2026, 33(3), 593-602. https://doi.org/10.32604/cju.2025.070162

Received 09 July 2025; Accepted 29 September 2025; Issue published 29 June 2026

Abstract

Objectives: Residual Disease after adjuvant chemotherapy for non-seminomatous germ cell tumor (NSGCT) poses a significant clinical challenge and difficulties in tailored management. This study aimed to externally validate the Heidenreich criteria among patients eligible for unilateral post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) for residual masses of NSGCT. Methods: For validation, these criteria were retrospectively applied in 23 patients undergoing PC-RPLND for residual masses of NSGCTs. In patients qualified for unilateral-modified PC-RPLND according to the Heidenreich criteria but treated with fully bilateral dissection, pathological reports were evaluated to identify teratoma or active cancer cells inside the contralateral field. Patients treated with unilateral-modified PC-RPLND were followed to identify relapse within the contralateral field. Results: Of those 23 patients included, 6 (26.1%) and 17 (73.9%) patients could have been treated with unilateral-modified or fully bilateral template dissection, according to the Heidenreich algorithm, respectively. Within a median follow-up of 85.4 months (IQR, 49.0–165.4), 4 (17.4%) and 2 (8.7%) retroperitoneal and distant recurrences occurred, respectively. Among these, 2 patients (40.0%) were treated with fully bilateral template resection. One patient (4.3%) experienced both distant and retroperitoneal recurrence. Of the 6 patients with an indication for a unilateral-modified PC-RPLND, one patient (16.7%) presented an in-field retroperitoneal recurrence. No recurrences were observed in the contralateral field when the unilateral-modified template dissection would have been performed according to the Heidenreich criteria. Conclusions: The retrospective application of the Heidenreich criteria in our cohort correctly classified our patients, facilitating a tailored selection for sparing a surgical procedure without interfering with oncological outcomes and potentially minimizing early and late complications.

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