Histopathologic Predictors of Relapse in Clinical Stage I Nonseminomatous Germ Cell Tumors
A Yilmaz, K Trpkov, T Cheng. Calgary Laboratory Services and University of Calgary, Calgary, Canada; Medical Oncology, TBCC Cancer Centre, Calgary, Canada
Background: The majority of nonseminomatous germ cell tumors of testis (NSGCT) present with clinical stage I non-metastatic disease, which has an excellent prognosis and cured by radical orchiectomy. A subset of patients however eventually show disease progression. We investigated the possible histologic predictors of disease relapse in patients with clinical stage I NSGCT, which in our institution are managed only by surveillance.
Design: Of a total of 395 germ cell tumors, resected in our center from 10/1999 to 06/2009, 152 (38%) were NSGCT. Pathology slides and reports were reviewed and follow-up was obtained for all patients. We evaluated the following clinical and morphologic features: clinical and pathologic stage at presentation, age, tumor size, histologic type and percentage of tumor components, coagulative tumor necrosis, vascular invasion, rete testis invasion, and extension beyond tunica albuginea into a.) tunica vaginalis, b.) hilar soft tissues, c.) epididymis or d.) spermatic cord. We used univariate and multivariate Cox regression analysis to correlate histologic parameters with disease relapse.
Results: Of the 152 NSGCT, 94 (62%) patients presented with clinical stage I disease. Mean patient age was 33 years (range, 17 to 74), with a mean tumor size of 3.5 cm (range, 0.8 to 10.5). Mixed tumor histology with more than one type was observed in 71 (75%) patients, while pure NSGCT were identified in 23(25%). Vascular invasion was detected in 28 (30%), necrosis in 67 (71%), rete testis invasion in 57 (61%). Extension into hilar soft tissues was identified in 17 (18%) tumors and invasion into spermatic cord and epididymis in was found in 3(3%) tumors each. Tunica vaginalis invasion was not seen in any tumor. After a mean follow-up of 28.4 months (range, 1 to 84), 26 (28%) patients relapsed. Only one patient (1%) died with metastatic disease. Median time to relapse was 5 months. Retroperitoneal nodes were the most common site of relapse. On univariate analysis, only vascular invasion (p<0.001) and presence of >90% embryonal carcinoma component (p=0.014) were significantly associated with disease relapse. On multivariate analysis vascular invasion was a stronger predictor of relapse (p<0.001) compared to presence of significant proportion of embryonal carcinoma (p=0.061).
Conclusions: Patients with clinical stage I NSGCT had excellent prognosis in this study. Vascular invasion and presence of >90% embryonal carcinoma were the only predictors of disease relapse in our patient cohort.
Category: Genitourinary (including renal tumors)
Monday, March 22, 2010 1:00 PM
Poster Session II # 96, Monday Afternoon