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. 2022 Dec;40(12):2879-2887.
doi: 10.1007/s00345-022-04063-7. Epub 2022 Jul 29.

Prognostic factors in patients with clinical stage I nonseminoma-beyond lymphovascular invasion: a systematic review

Friedemann Zengerling  1   2 , Dirk Beyersdorff  3 , Jonas Busch  4 , Julia Heinzelbecker  5 , David Pfister  6 , Christian Ruf  7 , Christian Winter  8 , Peter Albers  9 , Sabine Kliesch  10 , Stefanie Schmidt  11
Affiliations

Prognostic factors in patients with clinical stage I nonseminoma-beyond lymphovascular invasion: a systematic review

Friedemann Zengerling et al. World J Urol. 2022 Dec.

Abstract

Objective: To systematically evaluate evidence on prognostic factors for tumor recurrence in clinical stage I nonseminoma patients other than lymphovascular invasion (LVI).

Methods: We performed a systematic literature search in the biomedical databases Medline (via Ovid) and Cochrane Central Register of Controlled Trials (search period January 2010 to February 2021) for full text publications in English and German language, reporting on retro- or prospectively assessed prognostic factors for tumor recurrence in patients with stage I nonseminomatous germ cell tumors.

Results: Our literature search yielded eleven studies reporting on 20 potential prognostic factors. Results are based on cohort studies of mostly moderate to low quality. Five out of eight studies found a significant association of embryonal carcinoma (EC) in the primary tumor with relapse. Among the different risk definitions of embryonal carcinoma (presence, predominance, pure), presence of EC alone seems to be sufficient for prognostification. Interesting results were found for rete testis invasion, predominant yolk sac tumor, T-stage and history of cryptorchidism, but the sparse data situation does not justify their clinical use.

Conclusions: No additional factors that meet the prognostic value of LVI, especially when determined by immunohistochemistry, could be identified through our systematic search. The presence of EC might serve as a second, subordinate prognostic factor for clinical use as the data situation is less abundant than the one of LVI. Further efforts are necessary to optimize the use of these two prognostic factors and to evaluate and validate further potential factors with promising preliminary data.

Keywords: Embryonal carcinoma; Lymphovascular invasion; Nonseminoma; Prognosis; Prognostic factor; Recurrence.

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Conflict of interest statement

All other authors have no conflicts of interest to declare that are relevant to the content of this article.

Figures

Fig. 1
Fig. 1
Risk factors for relapse in clinical stage I testicular cancer
See this image and copyright information in PMC

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