TREATMENT OF STAGE I, II TESTICULAR TUMOR BASED ON TUMOR MARKERS

Aims and background Surveillance after orchiectomy alone has gained great popularity in the management of stage I NSGCTT. Preliminary results were enthusiastic, but critical voices have been raised against general use of this option as routine management. In an effort to identify patients at high risk of relapse, there has been a search for adverse prognostic factors of stage I nonseminomatous germ cell testicular tumors (NSGCTT). The aim of the study was to identify those patients in whom a surveillance policy is less likely to be successful. Methods Eighty patients with stage I NSGCTT were followed for at least 5 years. They were assigned to their respective clinical stage on the basis of physical examination, chest X-ray, CT of the retroperitoneum and post-orchiectomy tumor markers. The criteria for inclusion in clinical stage I were normal results of these examinations. The policy of surveillance consisted of regular follow-up with tumor markers, chest X-ray and CT of the retroperitoneum. Patients who relapsed were treated with cisplatin-containing chemotherapy. In all patients, diagnostic delay, pre-orchiectomy tumor markers, T staging category, size, histopathology and vascular invasion in the primary tumor, and semen analysis were recorded. Results Follow-up revealed that 51 of the 80 patients (63.7%) were free of disease 61-110 months (mean, 83.1) after orchiectomy. Relapse was detected in 29 patients (36.3%) 3-58 months (mean, 13) after orchiectomy. The overall survival rate was 95%. The main risk factors of relapse were: vascular invasion, a major embryonal carcinoma and a minor teratoma component in the primary tumor, and low sperm count before orchiectomy. Conclusions The authors recommend the following risk-adapted treatment procedures: retroperitoneal lymph node dissection in patients with vascular invasion and a major teratoma component, adjuvant chemotherapy in patients with vascular invasion and a major embryonal carcinoma component, and surveillance policy in patients without vascular invasion.

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Modified Retroperitoneal Lymphadenectomy for Patients with Clinical Stage I Testicular Tumor

The Journal of Urology ◽

10.1016/s0022-5347(17)75583-8 ◽

1987 ◽

Vol 137 (6) ◽

Cited By ~ 3

Author(s):

Jerome P. Richie ◽

Marc B. Garnick

Keyword(s):

Clinical Stage ◽

Testicular Tumor ◽

Stage I ◽

Retroperitoneal Lymphadenectomy

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Therapy in Stage I Non-Seminomatous Testicular Tumor

European Urology ◽

10.1159/000463502 ◽

1984 ◽

Vol 10 (1) ◽

pp. 1-9 ◽

Cited By ~ 13

Author(s):

L. Weissbach ◽

E.A. Boedefeld ◽

W. Oberdörster ◽

W. Vahlensieck

Keyword(s):

Testicular Tumor ◽

Stage I

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Stage I nonseminomatous germ cell testicular tumor: prediction of metastatic potential by primary histopathology.

Journal of Clinical Oncology ◽

10.1200/jco.1988.6.9.1467 ◽

1988 ◽

Vol 6 (9) ◽

pp. 1467-1473 ◽

Cited By ~ 90

Author(s):

C Y Fung ◽

L A Kalish ◽

G L Brodsky ◽

J P Richie ◽

M B Garnick

Keyword(s):

Risk Factors ◽

Prognostic Factors ◽

Germ Cell ◽

Vascular Invasion ◽

Clinical Stage ◽

Testicular Tumor ◽

Tumor Stage ◽

Nodal Metastasis ◽

Stage I ◽

Rational Approach

A study of 60 patients with clinical stage I nonseminomatous germ cell testicular tumor (NSGCT) was conducted to identify prognostic factors that may predict the likelihood of metastasis. Clinical features and histopathologic features of the primary testicular tumor were examined and analyzed for correlations with the presence of retroperitoneal nodal metastasis documented by surgery (N+) and with development of relapse (R+). Pathologic tumor stage greater than or equal to 2, with tumor extension into the tunica albuginea, rete testis, epididymis, or spermatic cord, was correlated with an increased rate of N+ compared with pathologic tumor stage I (P = .001). Vascular invasion was correlated with a higher rate of N+ (P = .05) and had a similar association with R+ (P = .08). Tumors containing less than 50% teratoma were found to have a higher rate of N+ than tumors with greater than or equal to 50% teratoma (P = .02). Based on the identified prognostic factors, a model for predicting the probability of retroperitoneal nodal metastasis in clinical stage I patients is proposed. The risk factors for nodal metastasis are: pathologic tumor stage greater than or equal to 2, vascular invasion, and less than 50% teratoma. Patients with none of the risk factors are considered at low risk and may be offered orchiectomy alone with surveillance for initial treatment. Patients with all three risk factors are at high risk and should be treated with a retroperitoneal lymph node dissection (RPLND) or possibly chemotherapy. Patients with one or two risk factors are at intermediate risk; it is recommended that they undergo RPLND. This risk model facilitates a rational approach to the management of clinical stage I NSGCT.

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SIGNIFICANCE OF MEASUREMENT OF SERUM LEVELS OF TUMOR MARKERS WITH GERMINAL CELL TESTICULAR TUMOR

The Japanese Journal of Urology ◽

10.5980/jpnjurol1928.71.4_352 ◽

1980 ◽

Vol 71 (4) ◽

pp. 352-362

Author(s):

Sadao Kamidono ◽

Soichi Arakawa ◽

Muneyoshi Masuda ◽

Gaku Hamami ◽

Nobori Shimatani ◽

...

Keyword(s):

Tumor Markers ◽

Testicular Tumor ◽

Serum Levels ◽

Germinal Cell

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Lymphatic Mapping and Gamma Probe Guided Laparoscopic Biopsy of Sentinel Lymph Node in Patients With Clinical Stage I Testicular Tumor

The Journal of Urology ◽

10.1097/00005392-200210010-00020 ◽

2002 ◽

pp. 1390-1395 ◽

Cited By ~ 1

Author(s):

CHIKARA OHYAMA ◽

YUTAKA CHIBA ◽

TETSURO YAMAZAKI ◽

MAREYUKI ENDOH ◽

SENJI HOSHI ◽

...

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Lymphatic Mapping ◽

Clinical Stage ◽

Gamma Probe ◽

Testicular Tumor ◽

Stage I ◽

Laparoscopic Biopsy

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Testicular Germ Cell Tumors: Serological and Immunohistochemical Diagnosis

Acta Medica Academica ◽

10.5644/ama2006-124.326 ◽

2021 ◽

Vol 50 (1) ◽

pp. 58

Author(s):

Ivan Damjanov

Keyword(s):

Germ Cell ◽

Tumor Markers ◽

Germ Cell Tumors ◽

Testicular Tumor ◽

Published Data ◽

Routine Practice ◽

Testicular Germ Cell Tumors ◽

Testicular Tumors ◽

Testicular Germ Cell ◽

Immunohistochemical Markers

This review deals with serologic and immunohistochemical tumor markers used in clinical laboratories for the diagnosis of testicular germ cell tumors. Time tested serologic markers such as alpha-fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase are routinely used in the work-up of patients with testicular tumors. Professional organizations regulating the practice of medicine in most countries worldwide require that the laboratory values for these serologic reactants be included in the pathology reports on testicular tumors as part of the tumor staging process. Immunohistochemical markers of testicular germ have been identified and widely tested during the first two decades of the XXI century. We have selected the most useful immunohistochemical markers from a few of these markers and discussed them in this review.Conclusion. Published data show that testicular tumor markers are widely used in routine practice. The study of tumor markers has improved the pathologic and clinical diagnosis of testicular germ cell tumors and has thus contributed to their treatment.

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