title: Prediction of metastatic status in non-seminomatous testicular cancer.
abstract: OBJECTIVE
  To examine the significance of 90 biomarkers for predicting metastatic status in non-seminomatous germ cell tumors (NSGCT). By predicting metastatic status, it may be possible to eliminate unnecessary therapeutic or diagnostic efforts.
  
  
  METHODS
  We investigated 552 males who were diagnosed with non-metastatic (n = 273) and metastatic (n = 279) NSGCT between 2000 and 2011. The sample included cancers of different histologies: embryonal cell carcinoma (n = 131), teratoma (n = 55), and mixed histology (n = 366). We collected and analyzed more than 90 parameters via logistic regression: demographic characteristics, medical history, histopathological parameters, and levels of tumor markers and hormones.
  
  
  RESULTS
  Testis histology (p = 0.004), clinical symptoms (p = 0.0005), tumor length (p = 0.005), infiltration of the rete testis (p = 0.008), invasion of lymphatic (pL1) and blood vessels (pV1) (p < 0.0001), and levels of enzymes such as LDH, βHCG, AFP, and FSH (p values as small as <0.0001) were associated with metastatic status. With one model, we identified 14 out of 76 (18.4 %) metastatic NSGCT cases with 93-100 % certainty (positive predictive value) at 99 % specificity by the peripheral blood levels of LDH (day of operation) in combination with FSH measurements (1 day after operation). A second model included pV, tumor length, and FSH (1 day after operation). It identified 25 out of 90 (27.8 %) non-metastatic NSGCT with approximately 90 % certainty (negative predictive value) at 94-98 % sensitivity.
  
  
  CONCLUSIONS
  No single parameter was able to discriminate metastatic from non-metastatic NSGCT, but combinations of parameters in two predictive models accurately identified the metastatic status in 23 % of the cases in our sample.
authors.affiliation: Department of Urology, Federal Armed Forces Hospital, 22049, Hamburg, Germany, Dr.ChristianRuf@gmx.de.
authors.forename: C G
authors.initials: CG
authors.lastname: Ruf
authors.forename: S
authors.initials: S
authors.lastname: Sachs
authors.forename: N
authors.initials: N
authors.lastname: Khalili-Harbi
authors.forename: H
authors.initials: H
authors.lastname: Isbarn
authors.forename: W
authors.initials: W
authors.lastname: Wagner
authors.forename: C
authors.initials: C
authors.lastname: Matthies
authors.forename: V
authors.initials: V
authors.lastname: Meineke
authors.forename: M
authors.initials: M
authors.lastname: Fisch
authors.forename: F K
authors.initials: FK
authors.lastname: Chun
authors.forename: M
authors.initials: M
authors.lastname: Abend
mesh_terms: D006801:Humans; D008297:Male; D015233:Models, Statistical; D009373:Neoplasms, Germ Cell and Embryonal / Q000453:epidemiology / Q000556:secondary*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D013736:Testicular Neoplasms / Q000473:pathology*