Stage III Testicular Non-Seminomatous Germ Cell Tumor AJCC v6 and v7

554 Background: The main objective of this study was to determine the clinical features, treatment, clinical outcome and prognosis of Down's syndrome (DS) patients with germ cell tumor (GCT). Methods: Literature search based on PubMed search was performed using the following keywords: “Germ cell tumor (GCT)” and “Down's syndrome”. A total of 85 cases of GCT in DS patients published in literature between January 1985 and October 2017 were identified. Results: Our final cohort of GCT in DS include 44 cases of testicular germ cell tumor (TGCT); 22 intracranial GCT, 2 primary mediastinal GCT, 3 gastrointestinal GCT, 9 retroperitoneal GCT, and 5 cases of ovarian GCT. The median age of forty-four testicular GCT was 30 years (range 2 years – 50 years). In most cases, cancer was diagnosed following the discovering of swelling by care provider or found incidentally (either painless or painful) in the region of the testes, although abdominal pain was a symptom in a few cases. 29 (66%) patients were diagnosed with seminoma and 15 (34%) with non-seminoma. In the seminoma group, 18 (62%) patients were diagnosed with stage I , 9 (31%) with stage II and 2 (7%) with stage III. In the non-seminoma group, 4 (27%) patients were diagnosed with stage I, 5 (33%) with stage II and 6 (40%) with stage III. Nearly all patients (94%) underwent orchiectomy. 52% patients received chemotherapy, with BEP being the most common administered regimen. 7 patients had retroperitoneal lymph node dissection ( RPLND). In the seminoma group, there were 5 deaths, 3 related to disease progression, 2 related to comorbidities, 1 died during chemotherapy. In the non-seminoma group, there were 2 deaths, 1 related to disease progression, 1 died during chemotherapy. The overall survival at 5 years for stage I was 100%, 76% for stage II and 68% for stage III. Conclusions: In this largest cohort of GCT in DS, we found TGCTs are often diagnosed at stage II or III. In addition, delayed diagnosis, comorbidities likely contributed to the inferior outcome in stage II/III TGCTs in patients with DS. Emphasis on education, better communication, early screening and detection, are needed to improve the outcome in this population.

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Clinical Characteristics of Testicular Nonseminomatous Germ Cell Tumor from West China: A 10-Year Experience of a Super regional Center

10.21203/rs.2.12356/v1 ◽

2019 ◽

Author(s):

Zeyu Chen ◽

Xingyuan Wang ◽

Dehong Cao ◽

Shi Qiu ◽

Jianbing Guo ◽

...

Keyword(s):

Germ Cell ◽

Germ Cell Tumor ◽

Tumor Size ◽

Clinical Characteristics ◽

Clinical Stage ◽

Cell Tumor ◽

Stage Iii ◽

West China ◽

Nonseminomatous Germ Cell Tumor

Abstract Obejectives: To evaluate the clinical characteristics and prognostic factors of Nonseminomatous Germ Cell Tumor (NSGCT). Patients and methods: Testicular cancer (TC) survey was conducted by Department of Urology, West China Hospital from 2008 to 2018. Details such as age, tumor size, tumor markers, histopathology, clinical stage, initial treatment, follow up, and clinical outcomes were provided by the database of our center. Tumor stage was classified according to the NCCN criteria(1). Results: Orchiectomy, chemotherapy and radio-therapy were the main treatments for these patients. Clinical stage I, stage II and stage III patients accounted for 74.6% (150), 7.5% (15) and 17.9% (36), respectively. After a median follow up time of 63 months, 4 patients relapsed during observation and 3 of them died. 4 patients died because of advanced malignancies. Among CSI patients, 2 relapsed and 1 died in 3 months after orchiectomy. No recurrence was found in CSII patients. 2 out of 29 stage III cases relapsed after treatment and 3 died of advanced cancer. The 3- and 10- year OS was 95.6% and 88.7%, respectively. For all the patients, the 3- and 10-year PFS was 94.9% and 88.8%. According to our data, we found that the meatastasis and tumor size were risk factors for NSGCTs. Conclusion: The present report showed a good prognosis at non-metastatic stage(CSI). However, the prognosis of advanced disease(CSII and CSIII) is significantly worse than that of early stage. We also found that maximum tumor diameter of >5cm was a potential risk factor for NSGCT.

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