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Meta-Analysis
. 2020 Mar;125(3):355-368.
doi: 10.1111/bju.14967. Epub 2020 Jan 8.

Lymphovascular invasion and presence of embryonal carcinoma as risk factors for occult metastatic disease in clinical stage I nonseminomatous germ cell tumour: a systematic review and meta-analysis

Joost M Blok  1   2 , Ilse Pluim  1 , Gedske Daugaard  3 , Thomas Wagner  3 , Katarzyna Jóźwiak  4   5 , Erica A Wilthagen  6 , Leendert H J Looijenga  7 , Richard P Meijer  1 , J L H Ruud Bosch  1 , Simon Horenblas  2
Affiliations
Meta-Analysis

Lymphovascular invasion and presence of embryonal carcinoma as risk factors for occult metastatic disease in clinical stage I nonseminomatous germ cell tumour: a systematic review and meta-analysis

Joost M Blok et al. BJU Int. 2020 Mar.

Abstract

Objective: To systematically review the literature on the prognostic value of lymphovascular invasion (LVI) and embryonal carcinoma (EC) for occult metastatic disease in clinical stage I nonseminomatous germ cell tumour (CS I NSGCT).

Materials and methods: The PubMed, Embase (OVID) and SCOPUS databases were searched up to March 2019. Studies reporting on the association between LVI and/or EC and occult metastatic disease were considered for inclusion. The quality and risk of bias were evaluated by the Quality in Prognosis Studies tool.

Results: We screened 5287 abstracts and 207 full-text articles. We included 35 studies in the narrative synthesis and 24 studies in a meta-analysis. LVI showed the strongest effect. Pooled rates of occult metastasis were 47.5% and 16.9% for LVI-positive and LVI-negative patients, respectively (odds ratio [OR] 4.33, 95% confidence interval [CI] 3.55-5.30; P < 0.001). Pooled rates of occult metastasis were 33.2% for EC presence and 16.2% for EC absence (OR 2.49, 95% CI 1.64-3.77; P < 0.001). Pooled rates of occult metastasis were 40.0% for EC >50% and 20.0% for EC <50% (OR 2.62, 95% CI 1.93-3.56; P < 0.001).

Conclusions: LVI is the strongest risk factor for relapse. The prognostic value of EC is high, but there is no common agreement on how to define this risk factor. Both EC presence and EC >50% have similar ORs for occult metastasis. This shows that the assessment of EC presence is sufficient for the classification of EC.

Keywords: meta-analysis; nonseminomatous germ cell tumour; pathology; prognostic factors; systematic review; testicular germ cell tumour.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
PRISMA diagram.
Figure 2
Figure 2
Forest plot of meta‐analysis for (A) LVI presence, (B) EC presence, (C) EC >50%.
See this image and copyright information in PMC

Comment in

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Supplementary concepts