Adult Testicular Germ Cell Tumor: Clinical Characteristics and Risk Factors for Recurrence / 대한비뇨기과학회지

ABSTRACT

PURPOSE: We reviewed clinical characteristics and prognostic factors in testicular germ cell tumor in adults. MATERIALS AND METHODS: We reviewed the records of 42 patients with testicular germ cell tumors managed at Seoul National University Hospital between January 1985 and May 1997. Patients were followed regularly to determine clinical outcome with tumor markers, chest X-ray and abdominal CT. Mean follow-up was 5.75 years ranging from 3months to 238months. RESULTS: Painless testiscular enlargement(86%) was the most common presenting symptom and history of cryptorchidism was noted in 6 patients. Among 21 seminoma patients, 11 were stage I, 9 were stage II, and 1 was unknown and among 21 nonseminomatous germ cell tumor(NSGCT) patients, 14 were stage I, 1 was stage II, 5 were stage III, and 1 was unknown. Of the 11 patients with stage I seminoma, there was no recurrence in 7 patients who received retroperitoneal low-dose radiation therapy after orchiectomy, but 2(50%) of 4 patients who had surveillance after orchiectomy, showed relapse at retroperitoneal lymph nodes. One of 3 patients who had elevated level of serum beta-HCG at initial presentation showed tumor relapse at retroperitoneal lymph node. Among 11 patients with stage I NSGCT under surveillance after radical orchiectomy, 7 patients(63.6%) had relapse. Vascular invasion of tumor was noted in orchiectomy specimens in 3 cases of the 7 relapsed cases compared to no vascular invasion in 4 non-relapsed cases. Also, 4 of 7 patients with elevation of tumor marker resulted in relapse. Although primary pathologic stage T2 was noted in 2 patients with clinical stage I NSGCT, no recurrence occurred after adjuvant combined chemotherapy. Fifteen patients with stage II or stage III were treated with systemic combination chemotherapy after radical orchiectomy and 7 of these patients had residual retroperitoneal mass. Of these patients, salvage chemotherpy was done in 2 patients, salvage RPLND and salvage chemotherapy with RPLND was performed in 1 patient respectively. Of the patients with stage II or III, One patient with stage IIB seminoma died despite of salvage chemotherapy with RPLND. The remaining 3 patients with residual mass were followed regulary without further treatment. They had no evidence of recurrence which was evaluated by tumor marker, chest X-ray and abdominal CT. The marked reduction of residual mass after adjuvant therapy were found in this group. The overall survival rate in total patients was 98% at 5.75 years from initial diagnosis. CONCLUSIONS: Adjuvant low-dose radiation therapy after radical orchiectomy was recommended to reduce recurrence rates in stage I seminoma. The vascular invasion, pre-orchiectomy elevation of tumor markers, or pathologic T2 or more stage were risk factors for relapse in stage I NSGCT. In advanced staged germ cell tumor, high survival rate was achieved by cis-platin based combination chemotherapy. Especially, in the patients with marked reduction of tumor mass after chemotherapy, close surveillance might be adequate in stead of second look operation for the retroperitoneal mass. Irrelevant of its histopathologic finding and stage, the testicular germ cell tumor showed excellent therapeutic end-results. Further studies should be directed at developing therapeutic modalities that could achieve better therapeutic results with least therapeutic complication and sequelae.