Selected trends in head and neck cancer epidemiology in Slovakia - an international comparison.

BACKGROUND: Head-and-neck malignant neoplasms (diagnosis group C00-C14, according to ICD-10) form a heterogeneous group of diseases with close anatomical localization. The incidence is twice to three times higher in men than in women and is increasing worldwide. OBJECTIVE: The aim of our analysis was to estimate changes of incidence and mortality rates of head-and-neck malignancies associated with anatomical topographic regions over the time as well as to compare these indicators in different selected countries of the world. Secondary endpoints included the assessment of patients' age distribution, clinical stages of newly diagnosed cases, and point prevalence of the disease in the Slovak Republic (SR). MATERIAL AND METHODS: The data base for the calculations was obtained from national databases and outputs of the National Cancer Registry (NCR) of the SR (with summary data available from the National Epidemiological Portal of Malignant Tumors, which analyzed data from 1984-2003 and was available until 2009, the remaining data were obtained from annual analyses of the NCR of the SR and the National Centre for Health Information (NCZI)), from the Statistical Office of the SR, and from the IARC WHO global database outputs on incidence, mortality, prevalence and survival of the patients. Incidence and mortality data in the SR were available up to 2012 (including) and up to 2021 (including), respectively. A log-linear joinpoint regression model was used to analyze the development of incidence and mortality rates over time by using Joinpoint Regression Program software. To achieve maximum precision in the estimated total surviving population of patients with head and neck malignant neoplasms, a model was developed to calculate the point (overall) prevalence based on absolute numbers of long-term registered national counts of newly diagnosed patients, mortality from the disease, overall mortality, and survival probability. The representation of clinical stages of head and neck carcinoma in the SR was compiled from available national data (2000-2012) and from predictions and does not consider changes in TNM classifications over the time. RESULTS: The age-adjusted (to the world standard population, ASR-W) incidence rate and the age-adjusted (ASR-W) mortality rate of head-and-neck malignant tumors in the SR have shown a significantly decreasing tendency in men since 1990; however, in women both of these indicators have shown a significant increasing tendency, especially the significantly growing incidence since 2004. In 2012, the overall age-adjusted incidence and mortality rate of head-and-neck cancers in the SR were significantly higher in males (ASR-W incidence 22.6/100,000 and ASR-W mortality 15.26/100,000) compared to females (ASR-W incidence 4.21/100,000 and ASR-W mortality 1.52/100,000). More than 75% of newly diagnosed cases are already in advanced and metastatic clinical stages, which is the most unfavourable survival factor. The absolute prevalence of these patients in the SR was estimated to be N = 9,395 in the year 2021. CONCLUSION: It is necessary to get a current and well evaluated epidemiological overviews to be able to plan preventive and intervention programs in oncology.

Personalities and their contribution to the development of radiation oncology.

Radiotherapy is an integral part of multidisciplinary clinical oncology as one of the basic treatment modalities. Historical evolution of radiation oncology from X-ray discovery, through the discovery of radioactivity by Maria Curie-Sklodowska and her husband Pierre Curie and other worldwide scientists do not appear without the overview of eminent personalities of Czech and Slovak radiotherapy, who have deserved to develop this medical field from its beginnings to the present time.

Bilateral testicular germ cell tumors - 50 years experience.

OBJECTIVE: This study analysed the characteristics and outcome of the patients with bilateral germ testicular cell cancer (TC), especially synchronous. METHODS: Among 2.124 TC patients diagnosed between 1970 and 2020, 96 (4. 5%) developed the 2nd TC. Nine occurred synchronously and 87 were metachronous. Patients were analysed according to the age and histological type of bilateral TC in comparison with unilateral TC. RESULTS: The mean follow-up of all 2,124 patients was 14.9 years. Unilateral TC occurred in 2.028 patients (the mean age of 32.4 years), 707 of them had seminoma, 1.310 nonseminomatous (NS) TC and 11 spermatocytic tumours. The 1st tumour of metachronous bilateral disease was diagnosed at a significantly younger age (27.1 years) compared to the unilateral disease (32.4 years). The mean interval between the 1st and the 2nd TC was 8.2 years. Patients with NSTC had a longer mean interval (9.2 years) between the 1st and the 2nd TC in comparison with seminoma patients (6.7 years). The mean age at diagnosis for seminoma was significantly higher (31.3 years) compared to the NSTC (24.1 years). Bilateral seminoma occurred in 5 synchronous bilateral TC patients, four patients had discordant histology, none presented with bilateral NSTC. CONCLUSIONS: Bilateral TC is a rare and requires individualized management of patients (Tab. 5, Fig. 4, Ref. 32).

Cervical cancer in pregnancy.

BACKGROUND: Cervical cancer is one of the most frequent cancers in pregnant women, despite this combination being a rare condition. More than 70% of cases are dia-gnosed in early stages and its treatment can be postponed after the delivery. Invasive cancer dia-gnosis in pregnancy is difficult for a patient, her family and doctors. A multidisciplinary team should take care of the patient and foetus and patients wishes are respected regarding her treatment and pregnancy. Radiotherapy in pregnancy is contraindicated. Neoadjuvant or adjuvant chemotherapy is therefore a main treatment method in patients with high risk disease either during pregnancy, or after the delivery. Neoadjuvant chemotherapy choice, delivery timing and definitive treatment are keys to mothers and childs health. Palliative treatment during pregnancy is extremely rare and the prognosis is poor. Bevacizumab and pembrolizumab are promising in the palliative treatment of non-pregnant patients. Neither bio-logical therapy by bevacizumab, nor immunotherapy by pembrolizumab can be administered to pregnant patient due to their mechanisms of action. PURPOSE: This overviews aim is to analyse data of cervical cancer treatment for pregnant women, focusing on dia-gnostics, therapy and delivery timing and treatment modalities choice according to the stage of the disease and gestational age. Individual approach is always necessary; our aim is, however, to emphasise current evidence-based recommendations in pregnancy. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

Assessment of Quality of Life in Patients with Head and Neck Cancer.

BACKGROUND: With the improvement of the results of oncological treatment, the concept of Quality of Life (QoL) has become increasingly important. Quantitative expression of the length of survival does not provide complete information on all advantages and disadvantages of the applied treatment. Hence, natural societal inquiry arises to answer the question what is QoL that such treatment option brings to the patient. With equivalent effi cacy of diff erent treatment modalities, the expected QoL after treatment might be the most important factor infl uencing the patients decision for a particular type of treatment. Questionnaires are the basic tools on quantifying QoL. Over the last decades, the development of questionnaire tools has undergone a signifi cant process of evolution and nowadays, many diff erent validated measures are available to assess the physical, functional, emotional, and social impact of cancer and its treatment on patients life. In head and neck cancer treatment, the assessment of QoL outcomes is especially important for patients and healthcare workers because of the potential negative impact of the treatment on important functions such as speech, swallowing, communication and social relationships. PURPOSE: The purpose of this article is to provide an up-to-date overview of validated questionnaire tools used in clinical practice with emphasis on potential future improvement in their design and clinical utility. The article defi nes the concept of QoL itself and currently available forms of its evaluation. Furthermore, the types of individual questionnaire tools are discussed within the text with practical and clearly arranged examples of world-famous validated scales evaluating specifi c items that represent the focus of research interest.

Extremely rare synchronous primary neoplasms in testicular cancer patients.

OBJECTIVES: This study analyzes the incidence of multiple primary malignant neoplasms (MPN) in patients with testicular cancer (TC), the results are compared with literature findings and assess the rarest subgroup of patients with MPN. PATIENTS AND METHODS: Clinical data of 1870 patients with TC treated or followed up in a single center in the period of 5/1970-12/2018 were collected and analyzed retrospectively in focus of the occurrence of MPN. RESULTS: The overall incidence of MPN was 150 (8.02 %). There were 89 cases of bilateral TC (59.3 %), of these 8 cases were synchronous (diagnosed within three months period from the primary diagnosis) and 81 metachronous (9 % and 91 % respectively). Non-testicular other primary malignancies (OPM) occurred in 61 cases (40.7 %), of which 59 cases were metachronous (96.7 %) and two cases were synchronous (3.3 %). Metachronous malignancies included mainly prostate cancer (n = 17 patients), kidney cancer (n = 13 patients) and colorectal cancer (n = 12 patients). Synchronous OPM was found in two patients. CONCLUSION: In our study we registered two cases of synchronous OPM, both histologically clear cell renal cancer. We have analyzed clinical characteristics, diagnosis and treatment strategies of synchronous OPM, in order to improve its diagnosis and therapy (Fig. 3, Ref. 22).

The effect of long term testosterone replacement therapy on bone mineral density.

OBJECTIVE: Long-term results of testosterone replacement therapy (TRT) on bone mineral density (BMD) in literature are still missing. MATERIALS AND METHODS: Totally, 45 males with testosterone deficiency syndrome (TDS) underwent TRT. The mean age was 57.84 years and the follow-up period was 94.62 months. Males were treated with three-month intramuscular injections of 1000 mg testosterone undecanoate. BMD was check at beginning of treatment, after two years and after 5 years. For a statistic evaluation, nonparametric Wilcoxon test was used. RESULTS: Mean BMD of lumbar spine was 1.067 at beginning, 1.122 after two years and 1.667 and after 5 years. The results after two and also 5 years showed a significant improvement (p < 0.001). CONCLUSION: Authors proved a positive effect of long-term TRT on BMD of the lumbar spine. Densitometry of the whole hip showed also an improvement, but only after 5 years. Densitometry of the femoral neck was relatively stable. Important is that despite the fact that males became older, BMD values of the lumbar spine were improved (Fig. 6, Ref. 18).

Malignant Tumors of the Penis - Dia-gnostics and Therapy.

BACKGROUND: Penile cancer belongs to group of relatively rare malignancies. It represents, on average, 0.5-1% of all tumours in males globally and occurs predominantly in older individuals (> 65 years). The geographical distribution of malignant cancer of the penis is reported. A higher incidence is observed in less developed parts of the world, particularly in South America, Southeast Asia, and some areas of Africa (> 2.0/100,000). In Slovakia, there has been a recent increase in incidence (1.1/100,000 in 2011). Mortality has stabilized at 0.3/100,000 in recent years. Significant risk factors for malignant cancers include social and cultural habits and hygienic and religious practices. Important risk factors are inadequate hygiene of the foreskin sac, phimosis, human papillomavirus infection, sexual promiscuity, smoking, genital infections, and a low socio-economic and educational status. PURPOSE: The present paper provides an overview of pathology, symptomatology, diagnostic approaches, and classification of the extent of the disease. Treatment of the primary tumour depends on the extent of the disease and includes topical treatment, photodynamic treatment, cryoablation, laser photocoagulation, conservative surgical treatment, especially circumcision, and even radical treatment - penile amputation with perineal urethrostomy. An important part of the management of this malignancy is surgical treatment of metastases in inguinal lymph nodes. The article devotes more attention to non-surgical treatment modalities, in particular radiotherapy (external and brachytherapy) and systemic therapy (chemotherapy and biologic therapy), offering an overview of the indications and regimens in the adjuvant, neoadjuvant and palliative approaches, with and without concomitant chemoradiotherapy, and describes possible adverse effects of the treatments.  Conclusion: Patients with penile cancer should be concentrated in centres that have abundant experience in the diagnosis and treatment of this disease. Key words penile cancer - surgical treatment - radiotherapy - chemotherapy - biologic therapy The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 12. 11. 2018 Accepted: 12. 12. 2018.

Results of long term testosterone replacement therapy in men with abdominal obesity, erectile dysfunction and testosterone deficiency.

INTRODUCTION: In this article, the authors evaluate subjective and objective results of long testosterone replacement therapy (TRT) and possible risk. METHODS: In a single center study, the authors treated 69 men with testosterone deficiency syndrome (TDS). The average age was 57.84 years and the follow-up period was 94.62 months. All men had at beginning a complete urological and internal examination. All the men were treated with three-month i.m. injections of 1000 mg testosterone undecanoate. The men were regularly checked according to the EAU guidelines. RESULTS: All of the men on treatment felt much better. Weight and waist circumference during monitoring showed a mild improvement. Excellent results were on red blood cells. Glucose, HDL cholesterol, triglycerides had stable values. PSA slightly increased and testosterone was within the normal range. In two men during treatment, we found a prostate cancer (low risk). Bone mineral density (BMD) of lumbar spine revealed a significant improvement. CONCLUSION: TRT had multiple positive effect on affected men with TDS. Our long-term results showed a long mild improvement during the time. Authors concluded that long term treatment had multiple benefit for affected men (Fig. 11, Ref. 13).

ESMO Consensus Conference on testicular germ cell cancer: diagnosis, treatment and follow-up.

The European Society for Medical Oncology (ESMO) consensus conference on testicular cancer was held on 3-5 November 2016 in Paris, France. The conference included a multidisciplinary panel of 36 leading experts in the diagnosis and treatment of testicular cancer (34 panel members attended the conference; an additional two panel members [CB and K-PD] participated in all preparatory work and subsequent manuscript development). The aim of the conference was to develop detailed recommendations on topics relating to testicular cancer that are not covered in detail in the current ESMO Clinical Practice Guidelines (CPGs) and where the available level of evidence is insufficient. The main topics identified for discussion related to: (1) diagnostic work-up and patient assessment; (2) stage I disease; (3) stage II-III disease; (4) post-chemotherapy surgery, salvage chemotherapy, salvage and desperation surgery and special topics; and (5) survivorship and follow-up schemes. The experts addressed questions relating to one of the five topics within five working groups. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel. A consensus vote was obtained following whole-panel discussions, and the consensus recommendations were then further developed in post-meeting discussions in written form. This manuscript presents the results of the expert panel discussions, including the consensus recommendations and a summary of evidence supporting each recommendation. All participants approved the final manuscript.

Late relapse in stage I of nonseminomatous germ cell testicular cancer on surveillance.

OBJECTIVE: Primary aim was to assess relapse­free survival (RFS) in patients with clinical stage I (CS I) of non-seminomatous germ cell testicular tumors (NSGCTT) undergoing surveillance after orchiectomy. The secondary aim was to examine differences in risk factors in patients with early relapse (ER 2 years) and very late relapse (VLR > 5 years). METHODS: Cross-sectional study analyzed 25­year single­center experiences with 198 CS I NSGCTT patients according the time to relapse. RESULTS: RFS was 160/198 (80.8 %). Relapse occurred in 38 (19.2 %) patients after a median fol-low-up of 7.57 months, 33 (86.8 %) patients had ER after a median follow-up of 7.03 months and 5 patients had LR (13.2 %) after a median follow-up of 26.28 months. One patient (2.63 %) had VLR after follow-up > 5 years (7.17 years). Three relapsed patients died with metastatic disease after a mean follow-up of 5.1 years from the date of diagnosis. Another three patients died without cancer after a mean follow-up of two years. OS was 192/198 (97 %). CONCLUSION: Diagnosis and treatment of late relapsing NSGCTT patients should be performed in experienced centers only. Occurrence of LR is the reason for long-term monitoring of NSGCTT survivors (Tab. 1, Fig. 1, Ref. 14).

Neutrophil-to-lymphocyte ratio as a predictor of preoperative tumor staging in testicular germ cell tumors.

OBJECTIVES: The aim of our study was to evaluate associations of elevated preoperative neutrophil-to-lymphocyte ratio (NLR) with testicular germ cell tumors (GCT) characteristics other than cancer specific survival (CSS) and progression free survival (PFS). BACKGROUND: NLR was recently presented as a widely available and inexpensive marker of poor prognosis in several types of solid tumors. Previous study showed no predictive value of NLR for CSS and PFS in testicular GCT. METHODS: Association of high NLR with histological type of tumor, presence of metastatic disease preoperatively and worse than T1 stadium in TNM classification preoperatively was analyzed in 103 patients who underwent radical orchiectomy for testicular GCT. RESULTS: No statistically significant difference in the prevalence of seminomas and non-seminomas neither in the group with NLR≥4 (p=0.6698) nor in the group with NLR<4 (p=0.9115) was detected. Similarly, no statistically significant difference in the prevalence of metastatic and non-metastatic disease in the group with NLR≥4 (p=0.2008), however statistically significant higher prevalence of non-metastatic disease in the group with NLR<4 (p=0.0001) was found. There was a statistically significant higher number of patients with worse than T1 stadium in patients with NLR≥4 (p=0.0105), but not significant difference in the group with NLR<4 (p=0.0956). CONCLUSION: The results of our study showed that NLR lower than 4 predicts non-metastatic disease and NLR higher or equal 4 predicts worse than T1 stadium (Tab. 3, Ref. 12).

[Recent Overview of Kidney Cancer Diagnostics and Treatment]. / Súcasný pohlad na diagnostiku a liecbu karcinómu oblicky.

The incidence of kidney cancer has increased in the majority of countries worldwide, and this disease has relatively high lethality. For many years, the Slovak Republic has been among the countries with the highest kidney cancer incidence, in particular in 2012 (according to global estimated values) in both genders, although mainly in females. In the last few years, the Czech Republic has had the highest incidence of kidney cancer worldwide. The use of imaging techniques such as ultrasound and computerized tomography has increased the detection of asymptomatic renal cell cancer. Etiological factors include lifestyle factors such as smoking, obesity, and hypertension. Nephrectomy and partial nephrectomy are the standard treatments. Locally confined tumors in stage T1 should be treated with kidney-preserving surgery. Minimally invasive surgery is often possible as long as the surgeon has the requisite experience. For patients with metastases, overall and progression-free survival can be prolonged by pharmacotherapy with VEGF and mTOR inhibitors. The resection or irradiation of metastases can be a useful palliative treatment for patients with brain or osseal metastases that are painful or increase the risk of fracture. Minimally invasive surgery and new systemic drugs have expanded the therapeutic options for patients with renal cell carcinoma. The search for new predictive and prognostic markers is now in progress.Key words: kidney cancer - epidemiology - risk factors - pathology - diagnosis - therapy The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 2. 12. 2016Accepted: 3. 1. 2017.

[Trends in Prostate Cancer Epidemiology in Slovakia - an International Comparison]. / Vybrané epidemiologické ukazovatele karcinómu prostaty na Slovensku v porovnaní so zahranicím.

INTRODUCTION: According to worldwide estimates, Slovakia is classed as a country with a medium-high incidence of prostate cancer. Current predictions indicate that in the near future prostate cancer will become the most frequent cancer among males in Slovakia. AIMS: The aims of the study presented in this paper were to analyse trends in the incidence and mortality of prostate cancer in Slovakia and compare these trends with those in other countries and regions of the world, predict epidemiological indicators of prostate cancer in Slovakia, and provide relevant and updated data for the purposes of further analyses and evaluation of the impacts of interventions. MATERIAL AND METHODS: National data were analysed for the period 1968-2009. Trends in prostate cancer incidence and mortality were extracted using the joinpoint regression model and are presented with correspoding 95% CI and p values. Predictions of incidence and prevalence were calculated for the years 2014 and 2015, resp. RESULTS: A significant increase in standardized incidence was observed in Slovakia (from 14.5/100,000 in 1980 to 49.0/100,000 in 2009), representing as much as a 6.7% annual percentage change in recent years. The mortality values showed a slower rate of increase, from 9.4/100,000 in 1980 to 13.3/100,000 in 2009, while national mortality of prostate cancer decreased in recent years. These facts have made prostate cancer the most prevalent malignant tumor in males in Slovakia. CONCLUSION: Unlike in other countries, in Slovakia, no peak in prostate cancer incidence with a subsequent drop is observed. Mortality values reveal a favorable trend in the current national data.Key words: prostate cancer - incidence - mortality - prevalence - clinical stages The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 14. 12. 2016Accepted: 25. 1. 2017.

Malignant Mesothelioma of the Tunica Vaginalis Testis. A Clinicopathologic Analysis of Two Cases with a Review of the Literature.

Paratesticular malignant mesothelioma is an extremely rare type of mesothelioma with only a limited number of reported cases. Its clinical differentiation is challenging, and its diagnosis is almost exclusively accidental. The major risk factor is exposure to asbestos, typically with a long latency between exposure and diagnosis. The current study presents the clinical data of two patients diagnosed with paratesticular malignant mesothelioma. We evaluated a large spectrum of risk factors in the patients histories. The histomorphological and immunohistochemical characteristics were analysed and put into the perspective of a broad differential diagnosis. Both cases of malignant epithelial mesothelioma of the tunica vaginalis testis clinically presented as unilateral hydroceles. Patients underwent surgery with the perioperative finding of a tumour. Radical inguinal orchiectomy was the treatment of choice for both patients. After comprehensive staging, the second patient underwent a second step of inguinal and pelvic lymph node dis- section. Follow-up visits revealed recurrence of the disease in the first patient. Resection of the tumour was performed. The histology confirmed the relapse of a tumour with identical features to those of the first tumour. Chemotherapy and radiotherapy were not indicated. Both patients are currently in complete remission. In conclusion, surgical treatment had a determinative role in the prognosis of these patients. Radical orchiectomy is the treatment of choice for localized disease. Lymph node dissection can be considered in the case of lymph node enlargement. There is a lack of evidence-based data for adjuvant chemotherapy and radiotherapy. Patients should be referred to experienced multidisciplinary cancer centres for a second opinion on histology, treatment, and a follow-up plan.Key words: mesothelioma - tunica vaginalis testis - hydrocele - asbestos exposure.

[History of Oncology in Slovakia]. / História onkológie na Slovensku.

The history of oncology in Slovakia is closely linked to the history of St. Elizabeth Hospital, which was set up in the mid-18th century by nuns of the St. Elizabeth Order in Bratislava. In the first half of the 20th century, a unit was set up in the hospital dedicated to diagnosis and treatment of cancer. Shortly after World War II, the unit was turned into the Institute for Cancer Research and Treatment. In 1950, St. Elizabeth Hospital was nationalized, and the Cancer Research Institute of the Slovak Academy of Science and the Institute of Clinical Oncology were located there as centers for oncological diagnosis and treatment. After the restitution of church property in the early 1990s, the hospital was returned to the Order of St. Elizabeth, which set up the St. Elisabeth Cancer Institute in the hospital premises in January of 1996. This year marks the 20th anniversary of this institute in its new premises and the 85th anniversary of the Institute of Radiumtherapy founded in Bratislava, and thus the establishment of institutional healthcare for cancer patients in Slovakia is the reason for balancing. We present a view of the consecutive changes in the organization, space and staff of the Institute and evaluate the impact of celebrities on medicine who developed oncology as a clinical, scientific and educational discipline in Bratislava and in other cities and regions of Slovakia.

Prognostic value of programmed-death-1 receptor (PD-1) and its ligand 1 (PD-L1) in testicular germ cell tumors.

BACKGROUND: Testicular germ cell tumors (TGCTs) belong to the most chemosensitive solid tumors; however, a small proportion of patients fail to be cured with cisplatin-based chemotherapy. Inhibitors of PD-1/PD-L1 pathways represent a new class of promising drugs in anticancer therapy. The aim of this study was to evaluate expression and prognostic value of PD-1 and PD-L1 in TGCTs. PATIENTS AND METHODS: Surgical specimens from 140 patients with TGCTs (131 with primary testicular tumor and 9 with extragonadal GCTs) were included into the translational study. PD-1 and PD-L1 expression was detected in the tumor tissue by immunohistochemistry using monoclonal antibodies, scored by the multiplicative quickscore (QS) method, compared with their expression in normal testicular tissue and correlated with clinicopathological characteristics and clinical outcome. RESULTS: None of the GCTs exhibited PD-1 protein, although expression of PD-L1 was significantly higher in GCTs in comparison with normal testicular tissue (mean QS = 5.29 versus 0.32, P < 0.0001). Choriocarcinomas exhibit the highest level of PD-L1 with decreasing positivity in embryonal carcinoma, teratoma, yolk sac tumor and seminoma. PD-L1 expression was associated with poor prognostic features, including ≥3 metastatic sites, increased serum tumor markers and/or non-pulmonary visceral metastases. Patients with low PD-L1 expression had significantly better progression-free survival [hazard ratio (HR) = 0.40, 95% confidence interval (CI) 0.16-1.01, P = 0.008] and overall survival (HR = 0.43, 95% CI 0.15-1.23, P = 0.040) compared with patients with high PD-L1 expression. CONCLUSIONS: In this translational study, we showed, for the first time, the prognostic value of PD-L1 expression in TGCTs and our data imply that the PD-1/PD-L1 pathway could be a novel therapeutic target in TGCTs.