Clinical Experience of Nonseminomatous Germ Cell Testicular Tumor: Risk Factors and Survival Rate

Song, Hee Won; Chung, Byung Ha; Hong, Sung Joon; Yang, Seung Choul; Lee, Jin Moo

Abstract

PURPOSE: We reviewed clinical features and survival rates of nonseminomatous germ cell testicular tumors(NSGCTs) and analyzed pathological risk factors of relapse in stage I group under surveillance program.
MATERIALS AND METHODS
Forty one patients were treated for primary NSGCTs from February 1983 to April 1998. 20(48.8%) patients were stage I and 19 of them were followed up under surveillance program after orchiectomy and 1 underwent orchiectomy and adjuvant therapy(RPLND and PVB chemotherapy). 11(26.8%) were stage II and 10(24.4%) stage III and all stage II and III patients underwent orchiectomy and adjuvant therapy. Statistical analysis with Fisher`s exact test was performed to identify that pathological risk factors affected relapse rate.
RESULTS
Mean age at diagnosis was 26 years(range 16-47) and mean follow-up period was 58 months(range 5-163). According to histopathological types, embryonal carcinoma, teratoma, teratocarcinoma and mixed type represented 19.5%, 26.8%, 7.3% and 46.3%, respectively. Among 41 patients, 33 showed significant elevation of tumor markers at diagnosis. The 5-year survival rates of stage I, II and III were 95%, 80% and 56%, respectively and overall 5-year survival rate was 82%. Among stage I patients under surveillance program, there was statistically significant increase of relapse rate in the patients with pathological risk factors(presence of embryonal elements, local stage T2 or higher, presence of lymphovascular invasion) as compared to those without.
CONCLUSIONS
In stage I NSGCT patients, if there are pathological risk factors after orchiectomy, aggressive therapy such as early retroperitoneal lymph node dissection or chemotherapy is selectively needed.