Artikel
Non-seminomatous testicular germ cell tumours with teratoma-free primaries exhibit a superior early relapse-free survival
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Autoren
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Pia Paffenholz
- Uniklinik Köln, Köln, Germany
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Georg Landwehr
- Uniklinik Köln, Köln, Germany
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Christoph Seidel
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Onkologie, Hamburg, Germany
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Anika Poch
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Onkologie, Hamburg, Germany
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Carsten Bokemeyer
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Onkologie, Hamburg, Germany
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Richard Cathomas
- Klinik für Onkologie, Kantonsspital Graubünden, St. Gallen, Switzerland
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Pailin Pongratanakul
- Klinik für Urologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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Andreas Hiester
- Klinik für Urologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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Peter Albers
- Klinik für Urologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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Martin Pichler
- Klinik für Onkologie, Universitätsklinikum Graz, Graz, Austria
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Susanne Krege
- Klinik für Onkologie, Bundeswehrkrankenhaus Koblenz, Koblenz, Germany
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Isabelle Syring-Schmandke
- Klinik für Onkologie, Saarland Universität, Homburg, Germany
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Julia Heinzelbecker
- Klinik für Onkologie, Universitätsklinikum Essen, Essen, Germany
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Tim Nestler
- Klinik für Onkologie, Universitätsklinikum Bonn, Bonn, Germany
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David Pfister
- Uniklinik Köln, Köln, Germany
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Axel Heidenreich
- Uniklinik Köln, Köln, Germany
| Veröffentlicht: | 28. März 2023 |
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Gliederung
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Introduction: Characteristics and outcome of non-seminomatous testicular germ cell tumours (NSGCT) with teratoma-containing primaries are still under debate.
Materials & methods: We performed a retrospective analysis including 557 patients with metastatic NSGCT as a registry study within the “German Testicular Cancer Study Group”.
Results: Of the eligible 557 patients with NSGCT, 237 (42%) of all orchiectomy specimens had teratoma-containing primaries, while 320 (58%) were teratoma-free. Teratoma-containing primaries had a significantly higher clinical stage (p=0.002) and worse prognosis (p=0.051) compared to teratoma-free specimens. Lymph node metastasis were significantly larger before (4.5 vs 2.5 cm; p<0.001) and after chemotherapy (3.5 vs 2.5 cm; p<0.001) in teratoma-containing primaries. Post-chemotherapy retroperitoneal lymph node dissection was performed in 57% of all patients. As teratoma-containing specimens revealed a significantly lower number of complete responses after chemotherapy, PC-PRLND was more often performed, with teratomatous elements being more often present in the PC-RPLND specimens compared to non-teratoma containing primaries.
Kaplan-Meier estimates revealed that 19% of all patients relapsed during a median follow-up of 56 months [29–112] with a median time to relapse of 10 months. Teratoma-containing had a significantly lower relapse-free survival (RFS) compared to teratoma-free NSGCT (relapse rate 24% vs 16%, p=0.020). 8% (45/533) of all patients died due to their disease. There was no difference regarding the tumour-specific survival between teratoma-containing NSGCT and teratoma-free NSGCT when looking at the entire cohort of patients (8% vs. 9%, p=0.563), however median overall survival was not reached.
Conclusion: In our study, NSGCT patients with teratoma-containing primaries showed a significantly higher clinical stage and worse prognosis at time of presentation compared to teratoma-free primaries. Furthermore, patients with teratoma-containing primaries showed a significantly worse relapse-free survival. Consequently, treating physicians should be aware of these patients portending a dismal prognosis and the presence of teratomatous elements might act as a reliable stratification tool for treatment decision in TGCT patients.
This project was supported by the “Koeln Fortune Program” in 2020 (Faculty of Medicine, University of Cologne, Germany).
