PURPOSE: To assess the prognostic value of histological parameters in patients with clinical stage I nonseminomatous germ cell tumors (NSGCTs) undergoing active surveillance post-orchiectomy.
METHODS: Prognoses and recurrence patterns were investigated in 78 patients with CSI NSGCT who underwent orchiectomy. Immediately following orchiectomy, patients participated in active surveillance between 1999 and 2013 at Sun Yat-sen University Cancer Center, Guangzhou, China.
RESULTS: 23.1 % of the 78 investigated patients with CSI NSGCT relapsed, within a median time of 5.6 months It was determined using multivariate analysis that lymph vascular invasion (LVI) (OR 6.521; 95 % CI 1.872-22.721; p = 0.003) and the predominant presence of yolk sac tumor (greater than 50 %) (OR 3.537; 95 % CI 1.076-11.628; p = 0.038) independently correlated with relapse-free survival (RFS). Patients were categorized accordingly into three risk groups: low risk (< 50 % presence of yolk sac tumor and LVI (-); n = 41), intermediate risk (50 % or greater presence of yolk sac tumor and LVI (+); n = 29), and high risk (50 % or greater presence of yolk sac tumor and LVI (+); n = 8). Relapse rates of the low-risk, intermediate-risk, and high-risk groups were 7.3, 31.0, and 75.0 %, respectively.
CONCLUSIONS: LVI and a predominant presence of yolk sac tumor are crucial risk factors for relapse of CSI NSGCT. For patients without either of these risk factors, active surveillance post-orchiectomy is a safe and effective approach for the initial management of CSI NSGCT.
Written by:
Li X, Guo S, Wu Z, Dong P, Li Y, Zhang Z, Yao K, Han H, Qin Z, Zhou F, Liu Z. Are you the author?
Department of Urology, Sun Yat-sen University Cancer Center, No. 651, East Dongfeng Road, Guangzhou, 510060, Guangdong Province, China.
Reference: World J Urol. 2014 Dec 4. Epub ahead of print.
doi: 10.1007/s00345-014-1454-7
PubMed Abstract
PMID: 25471669