Risk factors for relapse in clinical stage I nonseminomatous testicular germ cell tumors: results of the German Testicular Cancer Study Group Trial.
OBJECTIVE
To prospectively assess potential risk factors for relapse in clinical stage I nonseminomatous germ cell tumors of the testis (CS I NSGCT).


METHODS
From September 1996 to May 2002, 200 patients with CS I NSGCT were prospectively assigned to retroperitoneal lymph node dissection (RPLND), and risk factor assessment was performed within a multicenter protocol. One hundred sixty-five patients had an adequate minimum follow-up of 12 months (mean, 34.5 months) or had pathologic stage II.


RESULTS
Pathologic stage II disease was found in 27.9% of patients. Only 0.6% of patients relapsed in the retroperitoneum after confirmation of pathologic stage I disease. With reference pathology, vascular invasion (VI) was most predictive of stage in multifactorial analysis (accuracy, 65.1%). However, the positive predictive value (PPV) of VI to predict patients who have metastatic disease or relapse during follow-up was only 52.7%. With absent VI, low-risk patients had a negative predictive value (NPV) of 76.9%. With a combination of several risk factors, the PPV increased to 63.6% and the negative predictive value increased to 86.5%.


CONCLUSIONS
Even with an optimal combination of prognostic factors and reference pathology, more than one third of patients predicted to have pathologic stage II or relapse during follow-up will not harbor metastatic disease and, therefore, would be overtreated with adjuvant therapy. However, patients at low risk may be predicted at an 86.5% level, and thus, surveillance in highly compliant patients would be a valuable option. For high-risk patients, further reduction of adjuvant treatment is necessary.
Albers
Peter
P
Department of Urology, Bonn University, D-53105 Bonn, Germany. peter.albers@ukb.uni-bonn.de
Siener
Roswitha
R
Kliesch
Sabine
S
Weissbach
Lothar
L
Krege
Susanne
S
Sparwasser
Christoph
C
Schulze
Harald
H
Heidenreich
Axel
A
de Riese
Werner
W
Loy
Volker
V
Bierhoff
Erhard
E
Wittekind
Christian
C
Fimmers
Rolf
R
Hartmann
Michael
M
D000328:Adult; D000368:Aged; D002455:Cell Division; D005434:Flow Cytometry; D005858:Germany; D018237:Germinoma / Q000209:etiology* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D016015:Logistic Models; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000601:surgery; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012187:Retroperitoneal Space; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013736:Testicular Neoplasms / Q000209:etiology* / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome