Prognostic factors in clinical stage I nonseminomatous germ cell tumors of the testis: multivariate analysis of a prospective multicenter study. Swedish-Norwegian Testicular Cancer Group.
Between 1981 and 1986, 279 consecutive patients with clinical stage I (CS1) nonseminomatous germ cell tumors (NSGCT) of the testis underwent pathological staging (PS) with retroperitoneal lymphadenectomy (RPLND). Patients with retroperitoneal metastases (PS2) received adjuvant chemotherapy. The median follow-up time after RPLND was 50 months (range, 30 to 90). Clinical and histopathologic features were registered prospectively and analyzed for association with risk of having PS2, relapse despite pathological stage 1 (PS1) or the combined risk of either event, metastatic disease (MET). Seventy-five (26.9%) of the patients had PS2 disease, and 30 (14.7%) of the 204 PS1 patients relapsed, indicating that at least 105 (37.6%) of this CS1 population had subclinical MET at the time of orchiectomy. Four (1.4%) of the 279 CS1 patients died of testicular cancer. Multivariate analyses showed several variables to be significantly associated with outcome for the CS1 patients; vascular invasion in primary tumor and normal preorchiectomy serum alpha-fetoprotein (Pre-AFP) level indicated PS2 disease. If Pre-AFP was excluded from the model, the absence of teratoma or yolk sac elements in the primary tumor became significant predictors of PS2. Vascular invasion, absence of teratoma, and a short interval between orchiectomy and RPLND indicated increased risk of relapse in PS1 patients. Vascular invasion, normal Pre-AFP, absence of teratoma elements, and a short orchiectomy to RPLND interval were predictive of MET. Our results indicate that prognostic factors useful for stratification of CS1 patients with NSGCT to different treatment options may be established.
Department of Oncology, University Hospitals of Trondheim, Bergen, Norway.
O
O
Klepp
A M
AM
Olsson
H
H
Henrikson
N
N
Aass
O
O
Dahl
A E
AE
Stenwig
B E
BE
Persson
E
E
Cavallin-Ståhl
S D
SD
Fosså
L
L
Wahlqvist
D006063:Chorionic Gonadotropin / Q000032:analysis; D006801:Humans; D016015:Logistic Models; D008297:Male; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D009919:Orchiectomy; D011379:Prognosis; D011446:Prospective Studies; D012186:Retroperitoneal Neoplasms / Q000556:secondary; D012307:Risk Factors; D013724:Teratoma / Q000097:blood / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D013736:Testicular Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D000509:alpha-Fetoproteins / Q000032:analysis
D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins