Analysis of clinical-pathologic variables, staging and prognostic groups, and therapeutic results of 106 germ-cell testicular tumors

Abstract

Objectives: Retrospective review of 106 germ-cell testicular tumors treated in our center between 1992 and 2009.

Methods: Description and analysis of several clinical-pathologic and prognostic variables and survival analysis.

Results: 68% of our patients were diagnosed in the last 5 years. 54.7% presented seminoma histology. The mean age at diagnosis was 33.47 for the seminoma (S) and 27.63 for non seminoma (NS), p=0,001. The median tumoral size in mm was 45.99mm (globally). 44.3% presented elevation of at least one tumor marker; Alpha-fetoprotein (AFP) or Human chorionic gonadotropin (HCG) .29.3% in the S and 60.4% in NS; p=0.02. The percentage of patients with increased HCG in S was 29.3% and 52.1% in NS; p=0.017 and AFP was elevated in 5.2% of S and 45.8% of NS; P <0.001. Accordingly to the classification of The Royal Marsden Hospital 96.5% of S and 83.2% of NS were diagnosed in stage I-II. Using the classification of the International Germ Cell Cancer Collaborative Group (IGCCG) for patients with advanced disease, 98.2% of S and 83.2% of NS belonged to the good prognostic group. Regarding the risk factors for relapse in stage I S (Rete testis invasion (RTI) and tumoral size (TS)> 4cm) 28% of our patients presented both risk factors. 18% of stage I NS presented vascular (VI) or lymphatic invasion (LI). Following the treatment protocols in consideration with the histology, stage and risk factors, 100% of stage I S with both risk factors and 100% of NS with vascular or lymphatic invasion received adjuvant therapy. Almost all the stage II-IV S and NS received different protocols of chemotherapy. In 2.8% of stage II NS a retroperitoneal lymph node dissection was performed. Residual tumor resection was documented in eight patients with stage II-IV NS. With a median follow-up of 60 months, the event free survival (EFS) was 93.3%.

Conclusions: Our study has similar characteristics compared to other studies.