Treatment of clinical stage I non-seminoma

Abstract

Germ cell cancers are the most common solid tumors among men between 15 and 40 years. Non-seminomatous germ cell tumors (NSGCTs) represent a unique and exclusive cohort of germ cell tumor patients. Non-seminoma can harbor different histologic components. The most commonly found histologies are embryonal cell cancer, teratoma, yolk sack tumor and choriocarcinoma, as well as teratocarcinoma and seminoma, in combination with non-seminomatous germ cell tumors histologic types. The clinical definition of stage I non-seminoma is the absence of metastatic lesions on imaging and normal tumor markers. The cure rate for clinical stage I NSGCT is 99% and this can be achieved by three therapeutic strategies: Active surveillance with treatment at the time of relapse, retroperitoneal lymph node dissection or adjuvant chemotherapy. The balancing of these various strategies should always be based on an individual risk profile of NGSCG patient depending on the lymphovascular invasion of the tumor.

Keywords: Active surveillance; Germ cell tumors; Non-seminomatous germ cell tumors; Retroperitoneal lymph node dissection.

Figure 1

The worldwide incidence for testis cancer Incidence. (A) 1-year and 5-year prevalence and number of deaths in 2018 for testicular cancer; (B) Expected number of incident cases and deaths from 2018 to 2040 for testicular cancer. (GLOBOCAN 2018, https://gco.iarc.fr/).

Figure 2

The results of histochemical staining. (A) Microscope slides of yolk sac (10×); (B) embryonal cell carcinoma (5×); (C) choriocarcinoma (10×); (D) teratoma (5×).

Figure 3

Relapse rates according to different treatment strategies for NSGCT stage I [39,40]. RPLND, retroperitoneal lymph node dissection; NSGCT, non-seminomatous germ cell tumors; BEP, bleomycin, etoposide, and cisplatin.

Figure 4

Flowsheet of treatment of NSGCT stage I (modified after [4]). NSGCT, non-seminomatous germ cell tumors; LVI+, lymphovascular invasion; LVI−, no lymphovascular invasion; IGCCCG, International Germ Cell Cancer Collaborative Group; BEP, bleomycin, etoposide, and cisplatin; NS-RPLND, nerve-sparing retroperitoneal lymph node dissection; NSGCT, non-seminomatous germ cell tumor; CSI, clinical stage I.