Late relapsing germ cell tumors with elevated tumor markers

Abstract

Purpose Late relapsing germ cell tumors (LR-GCT) are considered a rare distinct biologic entity as their clinical presentation and response to treatment is different to early recurrences. While serum tumor markers (AFP and ß-HCG) play an important role at the time of first diagnosis to correctly classify prognosis and treatment of germ cell tumors, they may not have the same significance in a late relapse situation. Patients and methods Thirty-seven patients with LR-GCT with elevated serum tumor markers were identified in our database. Twenty-six patients underwent primary surgical resection of the late relapsing tumor. Eleven patients received salvage chemotherapy and a post-chemotherapy residual tumor resection. Serum tumor markers, histological findings and oncological outcome were analyzed. Results In the histopathological specimen, viable cancer was found in 20 cases (54%) and teratoma was found in 16 cases (43%). In nine cases (24%), a somatic-type malignant transformation was present. In 19 of 37 patients (51.4%), the late relapse specimen presented a histological type of GCT, which was not present in the primary histology. Twenty-two patients (59.5%) were included in follow-up analysis. Mean and median follow-up time was 62.2 and 53 months, respectively. Seventeen patients (77.3%) suffered a relapse or had progressive disease after LR therapy. Five patients (22.7%) have been relapse-free after LR therapy (mean FU 61.6 months). Ten patients died of disease during follow-up (45.5%) and had a mean time from LR to death of 66.4 months. Eleven patients were alive at last follow-up (mean FU 62.2 months). Relapse and survival rate were similar between patients who received primary resection of LR tumor and patients who received salvage chemotherapy followed by surgery. Conclusion Patients with a late relapsing germ cell tumor and elevated markers have a poor prognosis and a high risk for another relapse independent on primary treatment. The histological type and aggressiveness of a late relapsing tumor cannot be predicted with serum tumor marker levels at the time of diagnosis of LR. In up to 54% of cases, primary histology did not coincide with LR histology. Therefore, we propose primary surgical resection of a late relapsing tumor if a complete resection is feasible in order to gain exact histology and tailor further treatment.

A case of testicular cancer with retroperitoneal lymph node metastasis of teratoma with somatic‐type malignancy 18 years after initial treatment

“…Che et al . proposed surgical resection of tumor with LR if a complete resection was feasible in patients with teratoma with STM 18 . In the present case, a mass with teratoma with STM was resected at LR by L‐RPLND, and this prevented unnecessary chemotherapy.…”

Targeting CLDN6 in germ cell tumors by an antibody-drug-conjugate and studying therapy resistance of yolk-sac tumors to identify and screen specific therapeutic options

“…For four decades, cisplatin-based chemotherapy has remained the standard treatment approach for metastatic GCT. Overall, most of the GCT cases can successfully be cured by this strategy, but especially patients with YST receive a poor prognosis due to a high risk of developing therapy resistance, suggesting that the formation of YST represents a therapy escape mechanism of GCT cells (Che et al 2021 ).…”

Special Issue on Testis Cancer

“…Additional preoperative imaging calculations (“radiomics”) may aid in surgical planning as outlined by Nini et al[ 6 ]. Furthermore, the fruitful collaboration of dedicated medical oncologists and specialized surgeons may improve the outcome of patients with resistant disease as presented by Oing [ 7 ], and Hiester et al [ 8 ]. Lastly, Bremmer and Nettersheim et al [ 9 ] identified putative factors of cisplatin resistance on proteome level by mass spectrometry.…”