Risk stratification of pubertal children and postpubertal adolescents with clinical stage i testicular nonseminomatous germ cell tumors

Nicholas G. Cost, Jessica D. Lubahn, Mehrad Adibi, Adam Romman, Jonathan E. Wickiser, Ganesh V. Raj, Arthur I. Sagalowsky, Vitaly Margulis

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Purpose The COG (Children's Oncology Group) currently recommends surveillance for all children and adolescents with clinical stage I testicular germ cell tumors. However, up to 30% of adults with clinical stage I testicular germ cell tumors harbor occult metastatic disease. In adults with clinical stage I nonseminoma some groups advocate a risk stratified approach. Occult metastases were noted in 50% of patients with features such as lymphovascular invasion or embryonal carcinoma predominance in the orchiectomy. However, to our knowledge there are no data on the impact of high risk features in such pubertal children and postpubertal adolescents. Materials and Methods We reviewed an institutional testis cancer database for pubertal children and postpubertal adolescents younger than 21 years. We tested the hypothesis that lymphovascular invasion, or 40% or greater embryonal carcinoma in the orchiectomy specimen, would increase the risk of occult metastases, ie relapse during surveillance or positive nodes on retroperitoneal lymph node dissection. Results We identified 23 patients with a median age of 18.6 years (range 7.1 to 20.9) at diagnosis. Of these patients 14 (60.9%) were on surveillance, 9 (39.1%) underwent primary retroperitoneal lymph node dissection and none received initial chemotherapy. Seven patients (30.4%) had occult metastatic disease. High risk pathological features were found in the orchiectomy specimen in 12 patients (52.2%), including all 12 (52.2%) with 40% or greater embryonal carcinoma and 3 (13.0%) with lymphovascular invasion. Seven patients (58.3%) with high risk features had occult metastatic disease vs none (0%) without high risk features (log rank p = 0.031). Conclusions Approximately half of pubertal children and postpubertal adolescents with high risk clinical stage I testicular germ cell tumors harbor occult metastatic disease. These results may be useful when discussing prognosis and treatment with patients and families.

Original languageEnglish (US)
Pages (from-to)1485-1490
Number of pages6
JournalJournal of Urology
Volume191
Issue number5 SUPPL
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Embryonal Carcinoma
Orchiectomy
Lymph Node Excision
Neoplasm Metastasis
Testicular Neoplasms
Testicular Germ Cell Tumor
Nonseminomatous germ cell tumor
Databases
Recurrence
Drug Therapy
Therapeutics

Keywords

  • adolescent
  • germ cell and embryonal
  • neoplasm metastasis
  • neoplasms
  • puberty
  • testis

ASJC Scopus subject areas

  • Urology

Cite this

Risk stratification of pubertal children and postpubertal adolescents with clinical stage i testicular nonseminomatous germ cell tumors. / Cost, Nicholas G.; Lubahn, Jessica D.; Adibi, Mehrad; Romman, Adam; Wickiser, Jonathan E.; Raj, Ganesh V.; Sagalowsky, Arthur I.; Margulis, Vitaly.

In: Journal of Urology, Vol. 191, No. 5 SUPPL, 01.01.2014, p. 1485-1490.

Research output: Contribution to journalArticle

Cost, Nicholas G. ; Lubahn, Jessica D. ; Adibi, Mehrad ; Romman, Adam ; Wickiser, Jonathan E. ; Raj, Ganesh V. ; Sagalowsky, Arthur I. ; Margulis, Vitaly. / Risk stratification of pubertal children and postpubertal adolescents with clinical stage i testicular nonseminomatous germ cell tumors. In: Journal of Urology. 2014 ; Vol. 191, No. 5 SUPPL. pp. 1485-1490.
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abstract = "Purpose The COG (Children's Oncology Group) currently recommends surveillance for all children and adolescents with clinical stage I testicular germ cell tumors. However, up to 30{\%} of adults with clinical stage I testicular germ cell tumors harbor occult metastatic disease. In adults with clinical stage I nonseminoma some groups advocate a risk stratified approach. Occult metastases were noted in 50{\%} of patients with features such as lymphovascular invasion or embryonal carcinoma predominance in the orchiectomy. However, to our knowledge there are no data on the impact of high risk features in such pubertal children and postpubertal adolescents. Materials and Methods We reviewed an institutional testis cancer database for pubertal children and postpubertal adolescents younger than 21 years. We tested the hypothesis that lymphovascular invasion, or 40{\%} or greater embryonal carcinoma in the orchiectomy specimen, would increase the risk of occult metastases, ie relapse during surveillance or positive nodes on retroperitoneal lymph node dissection. Results We identified 23 patients with a median age of 18.6 years (range 7.1 to 20.9) at diagnosis. Of these patients 14 (60.9{\%}) were on surveillance, 9 (39.1{\%}) underwent primary retroperitoneal lymph node dissection and none received initial chemotherapy. Seven patients (30.4{\%}) had occult metastatic disease. High risk pathological features were found in the orchiectomy specimen in 12 patients (52.2{\%}), including all 12 (52.2{\%}) with 40{\%} or greater embryonal carcinoma and 3 (13.0{\%}) with lymphovascular invasion. Seven patients (58.3{\%}) with high risk features had occult metastatic disease vs none (0{\%}) without high risk features (log rank p = 0.031). Conclusions Approximately half of pubertal children and postpubertal adolescents with high risk clinical stage I testicular germ cell tumors harbor occult metastatic disease. These results may be useful when discussing prognosis and treatment with patients and families.",
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AU - Cost, Nicholas G.

AU - Lubahn, Jessica D.

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AU - Romman, Adam

AU - Wickiser, Jonathan E.

AU - Raj, Ganesh V.

AU - Sagalowsky, Arthur I.

AU - Margulis, Vitaly

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