Testicular Neoplasms: Primary Tumour Size Is Closely Interrelated with Histology, Clinical Staging, and Tumour Marker Expression Rates—A Comprehensive Statistical Analysis

Abstract

The role of primary tumour size (TS) in the clinical course of testicular tumours is incompletely understood. We retrospectively evaluated 641 consecutive patients with testicular neoplasms with regard to TS, histology, clinical stage (CS), serum tumour marker (STM) expression and patient age using descriptive statistical methods. TS ≤ 10 mm was encountered in 13.6% of cases. Median TS of 10 mm, 30 mm, 35 mm, and 53 mm were found in benign tumours, seminomas, nonseminomas, and other malignant tumours, respectively. In cases with TS ≤ 10 mm, 50.6% had benign tumours. Upon receiver operating characteristics analysis, TS of > 16 mm revealed 81.5% sensitivity and 81.0% specificity for detecting malignancy. In subcentimeter germ cell tumours (GCTs), 97.7% of cases had CS1, and CS1 frequency dropped with increasing TS. Expression rates of all STMs significantly increased with TS. MicroRNA-371a-3p (M371) serum levels had higher expression rates than classical STMs, with a rate of 44.1% in subcentimeter GCTs. In all, TS is a biologically relevant factor owing to its significant associations with CS, STM expression rates and histology. Importantly, 50% of subcentimeter testicular neoplasms are of benign nature, and M371 outperforms the classical markers even in subcentimeter tumours.

Testicular neoplasms: the interrelationships of serum levels of microRNA-371a-3p (M371) and classical tumor markers with histology, clinical staging, and age—a statistical analysis

“…A significant trend towards higher expression rates with increasing clinical stages was shown for each of the four tumor markers. This result mirrors the significant association of marker expression rates with primary tumor-size reported earlier (Dieckmann et al 2022a , 2019b ). The most likely biological explanation for this association is the higher number of marker secreting neoplastic cells in both, increasing primary tumor sizes and increasing clinical stages.…”

“…1 . Part of this descriptive analysis had been reported earlier (Dieckmann et al 2022a ). The distribution of ages is significantly different by overall comparison across histologic groups ( p < 0.001, Kruskal–Wallis test).…”

“…The following data were secured from hospital-based electronic case files: patient's age (years); histology of the surgical specimen categorized as seminoma (SE), nonseminoma (NS), benign tumor (BT), malignant tumor other than GCT (OM); clinical stage (CS) at diagnosis (only in GCTs); and preoperative elevation of serum tumor markers bHCG, AFP, LDH, M371. The majority of the patients had been included in previous reports on other issues (Dieckmann et al 2019a(Dieckmann et al , 2019b(Dieckmann et al , 2018(Dieckmann et al , 2022a.…”

Malignant ovarian and testicular germ cell tumors: Common characteristics but different prognoses

“…Without lymphovascular infiltration, the risk is much lower-approximately 15% [59][60][61]. Larger tumor size is associated with an increasing risk of relapse in testicular GCTs [62], and tumor size is a prognostic factor for relapse in stage I seminomas [63] as well as rete testis invasion. Tumor size is not associated with overall survival in ovarian GCTs [64,65], but its effect on risk for relapse or association with metastatic disease has not been investigated.…”

“…Tumor size is not associated with overall survival in ovarian GCTs [64,65], but its effect on risk for relapse or association with metastatic disease has not been investigated. Ovarian GCTs are seemingly larger at diagnosis (median 15 vs. 3-5 cm in testicular GCTs [62,66,67]), probably due to the localization in the abdomen and lack of symptoms from small ovarian GCT tumors, whereas even small testicular GCTs can give distinct symptoms with a palpable lump in the testicle. Hence, testicular GCTs are potentially easier to detect early.…”