Do the Extent or Location of Vascular Invasion Stratify the Risk of Relapse in Clinical Stage I Patients with Nonseminomatous Germ Cell Tumors (NSGCT)?
Asli Yilmaz, Tina Cheng, Kiril Trpkov. University of Calgary and Calgary Laboratory Services, AB, Canada; University of Calgary, AB, Canada
Background: Current focus of testicular cancer management is to reduce the treatment related morbidity without jeopardizing the excellent survival rate. Predictors of relapse are critical in tailoring clinical management of individual patients. Previous studies showed that vascular invasion (VI) in the primary tumor is associated with high risk of relapse in patients with clinical stage I NSGCT. Our objective was to investigate whether the extent and/or the location of VI will improve the risk stratification in patients with stage I NSGCT, who are managed by surveillance.
Design: We identified 94 (62%) patients with clinical stage I of a total of 152 NSGCT patients. All patients had radical orchiectomy in our center between 10/1999 and 06/2009. VI was detected in 27 (29%) of cases. All clinical stage I patients were initially managed by surveillance. Pathology slides and reports were reviewed and follow-up was obtained. Extent of VI was defined on H&E slides as focal (1-3 foci) vs. extensive (≥4 foci). We also documented the location of VI as hilar and/or extratesticular vs. parenchymal vessels. We recorded the following clinical and morphologic features: age, tumor size, histologic type, percentage of tumor components and pathologic stage.
Results: Patient mean age was 34 years (range, 18 to 74) and mean tumor size was 3.5 cm (range, 0.8 to 10.5). Mixed tumor histology was identified in 20 (74%) cases and pure embryonal carcinoma was identified in 7 (26%) cases. Embryonal carcinoma was the most common type of tumor identified in lymphovascular spaces, followed by yolk sac tumor. We found extensive VI in 20 (74%) cases and focal in 7 (26%). Hilar and/or extratesticular VI was identified in 15 (56%) cases and parenchymal in 12 (44%). After a mean follow-up of 48 months (range, 7 to 84), 18 (67%) patients relapsed and 2 (7%) patients died with metastatic disease. Median time to relapse was 10 months and the most common site of relapse was retroperitoneal nodes. Relapse rates did not differ significantly when stratified by the extent of VI (focal 86% vs. extensive 60%) or location (hilar 67% vs. parenchymal 67%).
Conclusions: Evaluation of VI by extent or location did not improve the risk stratification for relapse in the studied patient cohort. We confirm that the presence of VI in the primary tumor is an adverse prognostic parameter associated with high disease progression rate in patients with clinical stage I NSGCT.
Category: Genitourinary (including renal tumors)
Tuesday, March 1, 2011 1:00 PM
Poster Session IV # 77, Tuesday Afternoon