Evaluation of Relapse Risk Factors and Treatment Outcomes in Stage 1 Germ Cell Testicular Tumors

Year 2023, Volume: 50 Issue: 4 - Cilt 50, Sayı 4, 447 - 452, 29.12.2023

Yakup Duzkopru , Abdülkadir Koçanoğlu , Serkan Gülcü

https://doi.org/10.5798/dicletip.1411488

Abstract

Aim: This study aims to evaluate risk factors for relapse in stage 1 germ cell tumors (GCTs) and compare relapse and survival outcomes between treated and untreated patients.
Method: The study encompasses patients diagnosed with GCTs aged 18 and above, treated and monitored at our oncology clinic between 2012 and 2022. After excluding cases with secondary malignancies, 54 patients with confirmed histopathological stage 1 testicular tumors were analyzed. Patient data, treatment received, and follow-up information were recorded, and statistical analyses were performed using IBM SPSS Statistics version 22.0.
Results: In the seminoma subgroup, relapse was observed in 3 out of 24 (12.5%) patients. Although there was no statistically significant difference in terms of relapse between the groups with and without risk factors such as rete testis involvement and tumor diameter, it was observed that relapse occurred at a higher frequency in both risk groups. Among non-seminomatous tumors, 5 out of 30 (16.7%) patients experienced relapse. Although a notable numerical difference in lymphovascular invasion —a defined risk factor—was observed, statistical significance was lacking. A significant difference in relapse was observed between patients receiving adjuvant treatment and those who did not.
Conclusion: For both seminoma and non-seminomatous tumors at stage 1, surveillance is recommended for patients lacking identified risk factors. Nevertheless, patients with established risk factors warrant personalized consideration, weighing factors such as age, comorbidities, and preferences to guide treatment decisions.

Keywords

Testicular cancer, Seminoma, Germ cell tumors, Non seminomatous germ cell tumors, Adjuvant chemotherapy

References

• 1.Kobayashi K, Saito T, Kitamura Y, et al. Oncologicaloutcomes in patients with stage I testicular seminomaand nonseminoma: pathological risk factors for relapse and feasibility of surveillance after orchiectomy. DiagnPathol 2013; 8: 57
• 2.Demir C, Atmaca M. Taşdemir, E. Bulut, G. Primertestis lenfoması: Olgu sunumu. Dicle Medical Journal2010; 37: 171-3.
• 3.Cheng L, Albers P, Berney DM, et al. Testicularcancer. Nat Rev Dis Primers 2018; 4.
• 4. Ruf CG, Schmidt S, Kliesch S, et al. Testicular germ cell tumours' clinical stage I: comparison of surveillancewith adjuvant treatment strategies regardingrecurrence rates and overall survival-a systematicreview. World J Urol 2022; 40: 2889-900.
• 5.Motzer RJ, Agarwal N, Beard C, et al. Testicularcancer. J Natl Compr Canc Netw 2012; 10: 502-35.
• 6.Warde P, Specht L, Horwich A, et al. Prognosticfactors for relapse in stage I seminoma managed bysurveillance: a pooled analysis. J Clin Oncol 2002; 20:4448-52.
• 7.Aparicio J, Germa JR, Garcia del Muro X, et al. Risk-adapted management for patients with clinical stage Iseminoma: the Second Spanish Germ Cell Cancer Cooperative Group study. J Clin Oncol 2005; 23: 8717-23.
• 8.Aparicio J, Maroto P, del Muro XG, et al. Risk-adaptedtreatment in clinical stage I testicular seminoma: thethird Spanish Germ Cell Cancer Group study. J ClinOncol 2011; 29: 4677-81.
• 9.Aydin AM, Zemp L, Cheriyan SK, et al. Contemporarymanagement of early stage testicular seminoma.Transl Androl Urol 2020; 9: S36-S44.
• 10.Maier JG, Sulak MH and Mittemeyer BT. Seminomaof the testis: analysis of treatment success and failure.Am J Roentgenol Radium Ther Nucl Med 1968; 102:596-602.
• 11. Thomas GM. Over 20 Years of Progress in Radiation Oncology: Seminoma. Semin Radiat Oncol 1997; 7:135-45.
• 12.Nichols CR, Roth B, Albers P, et al. Activesurveillance is the preferred approach to clinical stageI testicular cancer. J Clin Oncol 2013; 31: 3490-3.
• 13.Carbonnaux M, Vinceneux A, Peyrat P, et al.[Treatment of testicular germ cell tumors relapse]. Bull Cancer 2020; 107: 912-24.
• 14.Alexandre J, Fizazi K, Mahe C, et al. Stage I non-seminomatous germ-cell tumours of the testis:identification of a subgroup of patients with a very low risk of relapse. Eur J Cancer 2001; 37: 576-82.
• 15.Klepp O, Olsson AM, Henrikson H, et al. Prognosticfactors in clinical stage I nonseminomatous germ celltumors of the testis: multivariate analysis of aprospective multicenter study. Swedish-NorwegianTesticular Cancer Group. J Clin Oncol 1990; 8: 509-18.
• 16.Dieckmann KP, Dralle-Filiz I, Matthies C, et al.Testicular seminoma clinical stage 1: treatmentoutcome on a routine care level. J Cancer Res Clin Oncol2016; 142: 1599-607.
• 17.Kollmannsberger C, Tandstad T, Bedard PL, et al.Patterns of relapse in patients with clinical stage Itesticular cancer managed with active surveillance. JClin Oncol 2015; 33: 51-7.
• 18.Schmoll HJ, Souchon R, Krege S, et al. Europeanconsensus on diagnosis and treatment of germ cellcancer: a report of the European Germ Cell CancerConsensus Group (EGCCCG). Ann Oncol 2004; 15:1377-1399. DOI: 10.1093/annonc/mdh301.