Clinical stage I (CSI) testicular germ cell tumors (TGCT) represents disease confined to the testis without metastasis and CSIS is defined as persistently elevated tumor markers (TM) after orchiectomy, indicating subclinical metastatic disease. This study aims at assessing clinical characteristics and oncological outcome in CSIS.
Data from five tertiary referring centers in Germany were screened. We defined correct classification of CSIS according to EAU guidelines. TM levels, treatment and relapse-free survival were assessed and differences between predefined groups (chemotherapy, correct/incorrect CSIS) were analyzed with Fisher's exact and Chi-square test.
Out of 2616 TGCT patients, 43 (1.6%) were CSIS. Thereof, 27 were correctly classified (cCSIS, 1.03%) and 16 incorrectly classified (iCSIS). TMs that defined cCSIS were in 12 (44.4%), 10 (37%), 3 (11.1%) and 2 (7.4%) patients AFP, ß-HCG, AFP plus ß-HCG and LDH, respectively. In the cCSIS group, six patients were seminoma and 21 non-seminoma. Treatment consisted of active surveillance, carboplatin-mono AUC7 and BEP (bleomycin, etoposide and cisplatin). No difference between cCSIS and iCSIS with respect to applied chemotherapy was found (p = 0.830). 5-year relapse-free survival was 88.9% and three patients (11%) in the cCSIS group relapsed. All underwent salvage treatment (3xBEP) with no documented death.
Around 1% of all TGCT were classified as cCSIS patients. Identification of cCSIS is of critical importance to avoid disease progression and relapses by adequate treatment. We report a high heterogeneity of treatment patterns, associated with excellent long-term survival irrespective of the initial treatment approach.
World journal of urology. 2021 Dec 02 [Epub ahead of print]
Maximilian Peter Brandt, C Ruf, K P Dieckmann, I Syring, C Ruckes, T Nestler, H U Schmelz, R Dotzauer, A Hiester, P Albers, D Nettersheim, C Bolenz, S H Loosen, A Heidenreich, D Pfister, A Haferkamp, F Zengerling, P Paffenholz, GESRU Academics Testis, Penile Cancer Group
Department of Urology and Pediatric Urology, University Medical Center Mainz, University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany. ., Department of Urology, Bundeswehrkrankenhaus Ulm, Ulm, Germany., Department of Urology, Asklepios Klinik Altona, Hamburg, Germany., Klinik Und Poliklinik Für Urologie Und Kinderurologie, Universitätsklinikum Bonn, Bonn, Germany., Interdisciplinary Center for Clinical Trials (IZKS), Mainz, Germany., Department of Urology, Federal Armed Service Hospital Koblenz, Koblenz, Germany., Department of Urology and Pediatric Urology, University Medical Center Mainz, University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany., Department of Urology, Düsseldorf University Hospital, Düsseldorf, Germany., Department of Urology, Urological Research Lab, Translational UroOncology, University Hospital Düsseldorf, Düsseldorf, Germany., Department of Urology, Ulm University Hospital, Ulm, Germany., Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Düsseldorf, Germany., Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany.