Testicular Germ-Cell Tumours: A Descriptive Analysis of Clinical Characteristics at First Presentation

Abstract

Introduction: Clinical characteristics of testicular germ cell tumours (GCTs) apparently change over time, and some vary geographically. The aim of this study is to document the clinical profile of contemporary GCT patients.

Patients and methods: Four hundred twenty-two Caucasian GCT-patients treated in one German centre during 2000-2017, were analysed in terms of patient-age, laterality, histology, tumour-size, clinical stages (CS), pathological (pT)-stages and serum biomarker expression. The results were analysed descriptively and compared with the literature.

Results: Median age was 36 years and 60.2% had seminoma. Βeta-human chorionic gonadotropin was expressed in 37.9% and alpha Fetoprotein in 25.6%. CS1 presenting stage was 66.6% of all GCT patients, 79.1% in seminoma, and 47.6% in nonseminoma. Tumour size was significantly associated with pT-stages and CS. Patients >50 years had significantly more seminoma (77.6%) than younger ones (57.9%). Comparison with literature data revealed a shifting towards higher age, lower CS, higher proportion of seminoma and striking differences of characteristics among geographic regions.

Conclusions: A typical contemporary clinical profile of testicular GCTs is presented in this study. Median age, relative incidence of seminoma and proportion of CS1 appear to be increasing over time. Striking differences among ethnic groups regarding the characteristics of GCT require further investigation.

Keywords: Clinical staging; Germ cell tumour; Nonseminoma; Seminoma; Tumour markers; Tumour size.

Fig. 1.

Association of tumour-size with pathological (pT)-stage. Waterfall plot showing the association of tumour-size with pT-stage. X-axis denotes patient numbers; y-axis denotes tumour-size in cm. The horizontal line represents the median tumour size of all cases. Each case is represented by one vertical bar. Cases are ranked according to tumour size. The plot illustrates that among the patients with >pT1, markedly more cases are located above the median line than in the pT1 group. Also, in the >pT1 group, more cases have very large tumours (>8 cm size).

Fig. 2.

Association of tumour size with clinical stages (CS). Box plot showing the associations of tumour size with CS. Each box represents one particular subgroup of the patient population. Horizontal line within box denotes median tumour size; upper and lower limits of boxes denote interquartile ranges (IQRs). Whiskers show lowest and highest values within a range of 1.5 IQR. Stars within boxes denote mean values of tumour size in the corresponding subgroups. The plot illustrates the markedly higher tumour sizes in patients with CS > CS1. This finding is almost identical in all groups examined: entire group of germ cell tumours (GCT), seminomas and nonseminomas.

Fig. 3.

Comparison of age groups ≤50 and >50 years. Horizontal boxes denote relative proportions (%) of clinical characteristics in age groups ≤50 and >50 years.