Bone Metastases in Non-Seminomatous Germ Cell Tumors: A 20-Year Retrospective Analysis

Abstract

Background: Non-seminomatous germ cell tumors (NSGCTs) represent a rare yet the most prevalent malignancy among young men. Bone metastases (BMs) are exceedingly uncommon in this neoplasm, and available data regarding the initial disease presentation, survival outcomes, and prognostic significance of BMs are limited. Methods: We conducted a retrospective analysis of 40 NSGCT patients with BMs treated between 2001 and 2021 in our tertiary care center. The cohort was stratified into synchronous (n = 29) and metachronous (n = 11) groups based on the presence of BM at diagnosis or only at relapse, respectively. We assessed overall survival (OS), progression-free survival (PFS), disease presentation, and treatments. Results: After a median follow-up of 93 months, the 5-year PFS and OS rates were 37.6% and 53.9% in the synchronous group and 18.2% and 36.4% in the metachronous group, respectively. At the initial diagnosis, most patients were classified into the IGCCCG poor prognostic group (n = 34, 85%). BMs were mostly asymptomatic (n = 23, 57.5%), involved the spine (n = 37, 92.5%), and could become visible only after disease response (n = 4, 10%). A pathological examination of resected bone lesions after first-line treatment revealed necrosis (n = 5, 71.4%), teratoma, or seminoma (both n = 1, 14.3%). At first relapse, eight patients in the synchronous group did not experience bone recurrence, while eight patients experienced recurrence at the initial affected bone site. Conclusions: In NSGCT patients, BMs often present asymptomatically and may initially be unnoticed. However, these patients may have a poorer prognosis compared to those in the IGCCCG poor prognostic group. Further studies including control groups are needed to assess the independent prognostic significance of BMs.

Keywords: bone metastases; chemotherapy; non-seminomatous germ cell tumor; prognosis; testicular cancer.

Figure 1

Overall survival in synchronous and metachronous groups. Abbreviations: metachron., metachronous; synchron., synchronous.

Figure 2

Progression-free survival in synchronous and metachronous groups. Abbreviations: metachron., metachronous; synchron., synchronous.

Figure 3

OS in patients by BM number and location. OS in synchronous group patients according to (A) number of BMs (unique or multiple) and (B) location (axial only, axial and appendicular, appendicular only). OS in metachronous group patients according to (C) number of BM (unique or multiple) and (D) location (axial only, axial and appendicular, appendicular only). Abbreviations: append., appendicular.