title: Risk stratification of pubertal children and postpubertal adolescents with clinical stage I testicular nonseminomatous germ cell tumors.
abstract: OBJECTIVE
  The COG (Children's Oncology Group) currently recommends surveillance for all children and adolescents with clinical stage I testicular germ cell tumors. However, up to 30% of adults with clinical stage I testicular germ cell tumors harbor occult metastatic disease. In adults with clinical stage I nonseminoma some groups advocate a risk stratified approach. Occult metastases were noted in 50% of patients with features such as lymphovascular invasion or embryonal carcinoma predominance in the orchiectomy. However, to our knowledge there are no data on the impact of high risk features in such pubertal children and postpubertal adolescents.
  
  
  METHODS
  We reviewed an institutional testis cancer database for pubertal children and postpubertal adolescents younger than 21 years. We tested the hypothesis that lymphovascular invasion, or 40% or greater embryonal carcinoma in the orchiectomy specimen, would increase the risk of occult metastases, ie relapse during surveillance or positive nodes on retroperitoneal lymph node dissection.
  
  
  RESULTS
  We identified 23 patients with a median age of 18.6 years (range 7.1 to 20.9) at diagnosis. Of these patients 14 (60.9%) were on surveillance, 9 (39.1%) underwent primary retroperitoneal lymph node dissection and none received initial chemotherapy. Seven patients (30.4%) had occult metastatic disease. High risk pathological features were found in the orchiectomy specimen in 12 patients (52.2%), including all 12 (52.2%) with 40% or greater embryonal carcinoma and 3 (13.0%) with lymphovascular invasion. Seven patients (58.3%) with high risk features had occult metastatic disease vs none (0%) without high risk features (log rank p = 0.031).
  
  
  CONCLUSIONS
  Approximately half of pubertal children and postpubertal adolescents with high risk clinical stage I testicular germ cell tumors harbor occult metastatic disease. These results may be useful when discussing prognosis and treatment with patients and families.
authors.affiliation: Division of Urologic Oncology, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Urology, University of Colorado School of Medicine, Aurora, Colorado. Electronic address: nicholas.cost@childrenscolorado.org.
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Cost
authors.affiliation: Division of Urologic Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Jessica D
authors.initials: JD
authors.lastname: Lubahn
authors.affiliation: Division of Urologic Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Mehrad
authors.initials: M
authors.lastname: Adibi
authors.affiliation: Division of Urologic Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Adam
authors.initials: A
authors.lastname: Romman
authors.affiliation: Division of Pediatric Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Wickiser
authors.affiliation: Division of Urologic Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Ganesh V
authors.initials: GV
authors.lastname: Raj
authors.affiliation: Division of Urologic Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Arthur I
authors.initials: AI
authors.lastname: Sagalowsky
authors.affiliation: Division of Urologic Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Vitaly
authors.initials: V
authors.lastname: Margulis
mesh_terms: D000293:Adolescent; D001808:Blood Vessels / Q000473:pathology; D002648:Child; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality / Q000473:pathology*; D010865:Pilot Projects; D011379:Prognosis; D018570:Risk Assessment; D013736:Testicular Neoplasms / Q000401:mortality / Q000473:pathology*; D055815:Young Adult
keywords: adolescent; germ cell and embryonal; neoplasm metastasis; neoplasms; puberty; testis