Scripties UMCG - Rijksuniversiteit Groningen
English | Nederlands

Stage I testicular germ cell tumor: histopathological aspects and a retrospective relapse analysis

(2019) Geubels, B.M. (Barbara)

Background & objective: Stage I testicular germ cell tumors (TGCT) are the most common
type of neoplasia among males aged 20 to 35 years. Patients at higher risk of relapse are
currently identified by histopathological risk factors; primary tumor size ≥ 4cm for all TGCT,
rete testis invasion for seminoma and lymphovascular invasion for non-seminoma. Relapse
rates for high-risk patients are 20% for seminoma and 50% for non-seminoma. Adjuvant
chemotherapy is known to minimalize this risk, but due to curation rates for relapses of over
95% and possibly severe long term adverse effects this is not given to all patients. Our goal is
to analyze other histopathological aspects and their relation to both relapse and established risk
factors in order to formulate a more detailed relapse risk estimation.
Methods: We performed a multicenter retrospective cohort study in a central region in the
Netherlands. Data on included patients were acquired from the National Cancer and Pathology
Registries (NKR and PALGA). Treating physicians provided data on relapse occurrence.
Tumor characteristics were compared with established risk factors and relapse occurrence.
Results: Primary tumor data were acquired for 511 patients: 303 seminoma and 208 nonseminoma. Relapse information was acquired for 83 patients with 7 confirmed seminoma
relapses and 28 non-seminoma relapses.
Conclusions: Necrosis was identified as a possible predictor of relapse for seminoma, whereas
intratubular germ cell neoplasia, unclassified (ITGCNU) presence could predict a lower relapse
rate within this group. For non-seminoma, possible factors with an increased risk of relapse
were necrosis and predominance of embryonal carcinoma.

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