Very Early Relapse (< 1 year) in de novo Metastatic Seminoma is Associated With Reduced Overall Survival

Abstract

Introduction: As the characteristics and outcome associated with relapse in seminomatous testicular germ cell tumors (STGCT) are still unclear, this study aims at evaluating the differences between very early relapse (VER) and later relapse (LR) in this cohort of patients.

Material and methods: This retrospective analysis included 459 patients with STGCT treated from 2000 to 2024, analysing patient characteristics with nonparametric statistics as well as follow-up using Kaplan Meier analyses. VER was defined as tumour recurrence < 12 months after successful treatment.

Results and limitations: About 94 (20%) patients relapsed during a median follow-up of 19 months [IQR 2-68]. De novo metastatic patients with VER (n = 38, 40%) showed a significantly higher number of clinical stages 2C-3 disease (21% vs. 4%, P = .007), M-stage (P = .009) at diagnosis as well as a higher HCG level (P = .030) and LDH levels (P < .001; >2x ULN P = .039) at start of chemotherapy compared to patients with LR (n = 56; 60%). Initial treatment did not significantly differ between VER and LR (P = .199). VER after initial metastatic disease was associated with a significantly reduced overall survival compared to LR (P = .046), however not after de novo stage I. Our study is limited by its retrospective design.

Conclusion: Relapse in seminoma occurred in 20% of all patients. In the initial metastatic stage, VER was associated with a higher metastatic burden at diagnosis compared to LR, leading to a reduced overall survival in VER. Consequently, treating physicians should be aware of these patients portending a worse prognosis, potentially discussing an early intensification of systemic treatment.

Keywords: Germ cell tumor; Overall survival; Seminoma; Systemic treatment; Testicular cancer.