Vascular invasion as a prognosticator of metastatic disease in nonseminomatous germ cell tumors of the testis. Importance in "surveillance only" protocols.
Forty-five nonseminomatous germ cell carcinomas of the testis were evaluated retrospectively to define the biologic features associated with the occurrence of metastatic disease. A statistical analysis of several pertinent clinical and pathologic factors was performed. The factors evaluated included: duration of symptoms before diagnosis, serum level of alpha-fetoprotein, serum or urinary level of human chorionic gonadotropin, testicular weight, extent of local tumor (pathologic T stage), and vascular invasion at the primary site. In each case, metastases were documented by a retroperitoneal node dissection, other biopsies, or by chest films. In 29 tumors with vascular invasion, 25 patients were seen with metastatic disease. In 16 tumors without vascular invasion, 3 patients demonstrated metastasis. The presence or absence of vascular invasion was strongly correlated with concomitant lymph node involvement or subsequent appearance of other metastatic disease (chi-square = 17.19). Additionally, vascular invasion in bifactoral++ analysis with tumor size and pathologic T stage proved a significant prognosticator even in low-staged (chi-square = 8.48) and small tumors (chi-square = 8.13). The implications of these findings, both as an adjunct to the staging of nonseminomatous germ cell tumors and in the management of clinical Stage I lesions, are discussed.
Moriyama
N
N
Daly
J J
JJ
Keating
M A
MA
Lin
C W
CW
Prout
G R
GR
D000293:Adolescent; D000328:Adult; D001808:Blood Vessels / Q000473:pathology; D002369:Castration; D006063:Chorionic Gonadotropin / Q000097:blood; D004407:Dysgerminoma / Q000473:pathology; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000097:blood / Q000473:pathology*; D011379:Prognosis; D012186:Retroperitoneal Neoplasms / Q000556:secondary; D012189:Retrospective Studies; D013724:Teratoma / Q000473:pathology; D013736:Testicular Neoplasms / Q000097:blood / Q000473:pathology*; D000509:alpha-Fetoproteins / Q000032:analysis
D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins