Predictors of Advanced Clinical Stage in Nonseminomatous Germ Cell Tumors (NSGCT) of Testis: A Clinicopathologic Study of 152 Cases
A Yilmaz, T Cheng, K Trpkov. Calgary Laboratory Services and University of Calgary, Calgary, AB, Canada; Medical Oncology, TBCC Cancer Centre, Calgary, Canada
Background: Clinical staging is the first step in the management of GCT. Majority of patients with GCT present with low stage non-metastatic disease. A subset of patients however present with metastases involving the retroperitoneal nodes or distant sites (stages II & III). We investigated the histologic predictors of metastasic disease at presentation in a large single centre cohort of NSGCT.
Design: From a total of 395 GCT, we identified 152 (38%) NSGCT, resected in our center from 10/1999 to 06/2009. Slides and reports were reviewed and the following clinical and morphologic features were examined: age, tumor size, coagulative tumor necrosis, vascular invasion, rete invasion (RTI) and pattern of RTI (pagetoid and direct). Tumor extension beyond tunica albuginea (into tunica vaginalis, hilar soft tissue, epididymis or spermatic cord) was recorded. Parameters were correlated with the clinical stage at presentation using univariate and multivariate Cox regression analysis.
Results: Mean patient age was 31 years (range, 17 to 83). Mean tumor size was 4.1 cm (range, 0.6 to19). Clinical stage I was found in 94 (62%) patients; 26 (17%) and 28 (18%) were stage II and III, respectively (stage was not available in 4 (3%) cases). Vascular invasion was found in 63 (41%) and necrosis was seen in 113 (74%) cases. RTI was seen in 97 (64%) tumors: in 72 (47%) cases invasion was direct pattern and in 25 (16%) it was pagetoid only. RTI was not found in 44 (29%) cases; in 11 (7%) rete could not be seen. Tumor invasion into hilar soft tissue was found in 41 (27%) cases. Epididymis and spermatic cord extension were identified in 12 (8%) tumors each. Tunica vaginalis invasion was not seen in any case. On univariate analysis, the following parameters had a significant association with the clinical stage at presentation: tumor size (p=0.010), vascular invasion (p<0.001), RTI with direct pattern (p<0.001), hilar soft tissue extension (p=0.001), epididymis invasion (p=0.009), spermatic cord invasion (p=0.009) and necrosis (p=0.050). On multivariate analysis, only vascular invasion (p=0.002) and the RTI with direct pattern showed significant association with advanced clinical stage.
Conclusions: Although multiple parameters correlated with advanced clinical stage of NSGCT at presentation, on multivariate analysis, only vascular invasion and RTI with direct pattern were associated with metastases. Our findings suggest that the pattern of RTI in NSGCT should be routinely reported.
Category: Genitourinary (including renal tumors)
Monday, March 22, 2010 9:00 AM
Platform Session: Section A, Monday Morning