Predictors of Occult Metastasis in Clinical Stage I Nonseminoma: A Systematic Review

Vergouwe, Yvonne; Steyerberg, Ewout W.; Eijkemans, Marinus J.C.; Albers, Peter; Habbema, J. Dik F.

doi:10.1200/jco.2003.01.094

Cited by 156 publications

(79 citation statements)

References 62 publications

(36 reference statements)

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“…Histopathologic predictors of occult metastatic disease in nonseminomatous germ cell tumors have been previously studied in clinical stage I patients. 20 The studies, however, differ according to the treatment approach used. Metastatic disease either was defined by relapse rates in patients managed initially by surveillance, 9,10,13,15,21 or was determined by the presence of metastatic disease found on retroperitoneal lymph node dissection in patients who underwent surgical staging.…”

Section: Discussionmentioning

confidence: 99%

Testicular hilum and vascular invasion predict advanced clinical stage in nonseminomatous germ cell tumors

Yilmaz

Cheng²,

Zhang

et al. 2013

Modern Pathology

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Clinical staging is a critical step in the management of testicular germ cell tumors. Up to one-third of nonseminomatous germ cell tumors of the testis present with metastatic disease (clinical stages II and III). We investigated the predictors of metastatic disease at presentation in a cohort of 148 consecutive nonseminomatous germ cell tumors of the testis, over a 10-year period. The following clinical and pathologic features were evaluated: age, tumor size, dominant tumor histology, coagulative necrosis, vascular invasion, rete testis invasion and tumor extension into tunica vaginalis, hilar soft tissue, epididymis, or spermatic cord. Studied parameters were correlated with the clinical stage at presentation. Of the 148 patients with nonseminomatous germ cell tumors of the testis, 94 (63%) were clinical stage I, 26 (18%) were stage II, and 28 (19%) were stage III at presentation. Mean patient age was 31 years (range, 17-83). Mean tumor size was 4.1 cm (range, 0.6-19). On univariate analysis, the following parameters showed statistically significant association with the advanced clinical stage at presentation: vascular invasion (Po0.001), rete testis invasion (Po0.001), hilar soft tissue invasion (Po0.001), epididymis invasion (P ¼ 0.005), spermatic cord invasion (P ¼ 0.005), and coagulative necrosis (P ¼ 0.062). On multivariate analysis, only vascular invasion (P ¼ 0.011) and invasion into the rete testis and the hilar soft tissues (P ¼ 0.007 and P ¼ 0.017, respectively) demonstrated significant association with advanced clinical stage at presentation. We conclude that in addition to vascular invasion, tumor invasion into the hilum (rete testis or hilar soft tissue) is also strongly associated with metastatic disease at presentation and should be part of the routine pathology reporting.

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Section: Discussionmentioning

confidence: 99%

Testicular hilum and vascular invasion predict advanced clinical stage in nonseminomatous germ cell tumors

Yilmaz

Cheng²,

Zhang

et al. 2013

Modern Pathology

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“…NS stage I surveillance Retrospective series identified the histological presence of vascular invasion as the strongest predictor of relapse in stage I NSGCTs (Freedman et al, 1987;Vergouwe et al, 2003). Surveillance as a strategy for the management of stage I tumours was prospectively studied by the Medical Research Council and their results were published in 1992 (Read et al, 1992).…”

Section: Nonseminoma Stage Imentioning

confidence: 99%

“…Such patients are typically offered 'adjuvant' chemotherapy in the form of two cycles of BEP with subsequent recurrences uncommon indeed (Donohue et al, 1993;Spermon et al, 2002;Albers et al, 2003). Patients without evidence of nodal metastases demonstrate relapse rates between 10 and 13%, the vast majority of which are pulmonary in nature and occur within the first year.…”

Section: Nonseminoma Stage Imentioning

confidence: 99%

“…The options for men with stage I NSGCTs (post orchidectomy) are close surveillance or adjuvant chemotherapy (in the form of two cycles of BEP chemotherapy). Adjuvant primary retroperitoneal lymph node dissection (RPLND) is rarely performed within the United Kingdom, but we present a discussion of the pertinent issues.NS stage I surveillance Retrospective series identified the histological presence of vascular invasion as the strongest predictor of relapse in stage I NSGCTs (Freedman et al, 1987;Vergouwe et al, 2003). Surveillance as a strategy for the management of stage I tumours was prospectively studied by the Medical Research Council and their results were published in 1992 (Read et al, 1992).…”

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confidence: 99%

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Evidence-based pragmatic guidelines for the follow-up of testicular cancer: optimising the detection of relapse

Gilbert

Money-Kyrle

et al. 2008

Br J Cancer

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Testicular germ cell tumours (TGCTs) are the most common cause of cancer in men between the ages of 15 and 40 years, and, overall, the majority of patients should expect to be cured. The European Germ Cell Cancer Consensus Group has provided clear guidelines for the primary treatment of both seminoma and nonseminomatous germ cell tumours. There is, however, no international consensus on how best to follow patients after their initial management. This must promptly and reliably identify relapses without causing further harm. The standardising of follow-up would result in optimising risk-benefit ratios for individual patients, while ensuring economic use of resources. We have identified the seven common scenarios in managing seminomas and nonseminomas of the various stages and discuss the pertinent issues around relapse and follow-up. We review the available literature and present our comprehensive TGCT follow-up guidelines. Our protocols provide a pragmatic, easily accessible user-friendly basis for other centres to use or to adapt to suit their needs. Furthermore, this should enable future trials to address specific issues around follow-up giving meaningful and useful results. BackgroundTesticular germ cell tumours (TGCTs) are uncommon malignancies but the most common cause of cancer in men between the ages of 15 and 40 years. The peak incidence for nonseminomatous germ cell tumour (NSGCT) is between 20 and 30 years of age, and for seminoma between 30 and 40 years. In the United Kingdom, the incidence rate is only 1 : 100 000 men per year with a lifetime risk of developing a TGCT of 1 in 400 and 1900 new cases per year (Horwich, 2002). There has, however, been a steady increase in the incidence of TGCTs in European countries in the last two decades (Bergstrom et al, 1996). The reasons for this increasing incidence and the aetiology of TGCTs remain unknown. The European Germ Cell Cancer Consensus Group has provided clear guidelines for the primary treatment of both seminoma tumour and NSGCT (Schmoll et al, 2004). There is, however, a lack of clear consensus on how to follow patients after primary treatment, and a number of issues dictate that follow-up should be carefully thought out and rigorously adhered to. Here, we discuss these factors as they pertain to male germ cell tumour (GCT) practice and describe our recently developed protocols. Rational for follow-upDetecting relapse In general, detecting relapse is the major reason for maintaining follow-up and is the main focus of this review. The management of testicular cancer has been a major oncological success story, and provides a model for the management of curative solid tumours (Horwich et al, 2006). The use of platinumbased chemotherapy schedules has resulted in high cure rates for all stages of the disease (International Germ Cell Cancer Collaborative Group, 1997). The fact that the majority of young men treated for testicular cancer have a durable response to primary treatment has resulted in the accumulation of significant data on both the patterns ...

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“…Subsequent studies have shown that vascular invasion (VI) is the single most important prognostic factor regarding risk of relapse [14][15][16][17]. Without adjuvant treatment, the high-risk group (VI positive) has a 3-year relapse rate of approximately 50%, while low-risk patients (VI negative) have a relapse risk of 10 to 20% [1,3,[16][17][18][19][20][21][22].…”

Section: Prognostic Risk Factorsmentioning

confidence: 99%

Current Concepts in Management of Stage I NSGCT

Ahluwalia

Gautam

2016

Indian J Surg Oncol

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While about 50% of non-seminomatous germ cell tumors of the testes present as clinical stage I (CSI), further management of these patients continues to be mired in controversy. Active surveillance is a frontline option for low-risk CS I patients and according to some, even the high-risk ones with high embryonal carcinoma (ECA) component and vascular invasion (VI). However, it carries the disadvantage of long-term surveillance, the need for prolonged chemotherapy in case of recurrence and the possibility of secondary malignancies due to radiation exposure from frequent CT scans. One or two cycles of BEP chemotherapy is a popular alternative to active surveillance which carries a very low relapse rate, but valid concerns about overtreatment of a majority of patients, with the attendant chemotherapy-related toxicity exist. Retroperitoneal lymph node dissection has been used as a means of avoiding chemotherapy, especially in high-risk patients, but carries the disadvantage of a high surgical morbidity and complications. As with any major surgical procedure, the best results are dependent on the experience and skill of the individual surgeon.

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Predictors of Occult Metastasis in Clinical Stage I Nonseminoma: A Systematic Review

Abstract: Several strong predictors for occult metastasis were identified. A risk-adapted treatment policy should be developed that incorporates all relevant predictors so that adjuvant therapy is targeted better to those with occult metastases.

Cited by 156 publications

References 62 publications

Testicular hilum and vascular invasion predict advanced clinical stage in nonseminomatous germ cell tumors

Testicular hilum and vascular invasion predict advanced clinical stage in nonseminomatous germ cell tumors

Evidence-based pragmatic guidelines for the follow-up of testicular cancer: optimising the detection of relapse

Current Concepts in Management of Stage I NSGCT

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