Clinical characteristics, treatment patterns and relapse in patients with clinical stage IS testicular cancer

Robert Dotzauer ,Friedemann Zengerling ,Christian Bolenz ,Christian Ruf ,Axel Heidenreich ,Andreas Hiester ,Pia Paffenholz ,Maximilian Peter Brandt ,Tim Nestler ,Daniel Nettersheim ,Peter Albers ,Axel Haferkamp ,Hans Ulrich Schmelz ,Christian Ruckes ,Sven H. Loosen ,Klaus‐Peter Dieckmann ,David Pfister ,Isabella Syring

doi:10.1007/s00345-021-03889-x

Abstract

PurposeClinical stage I (CSI) testicular germ cell tumors (TGCT) represents disease confined to the testis without metastasis and CSIS is defined as persistently elevated tumor markers (TM) after orchiectomy, indicating subclinical metastatic disease. This study aims at assessing clinical characteristics and oncological outcome in CSIS.MethodsData from five tertiary referring centers in Germany were screened. We defined correct classification of CSIS according to EAU guidelines. TM levels, treatment and relapse-free survival were assessed and differences between predefined groups (chemotherapy, correct/incorrect CSIS) were analyzed with Fisher’s exact and Chi-square test.ResultsOut of 2616 TGCT patients, 43 (1.6%) were CSIS. Thereof, 27 were correctly classified (cCSIS, 1.03%) and 16 incorrectly classified (iCSIS). TMs that defined cCSIS were in 12 (44.4%), 10 (37%), 3 (11.1%) and 2 (7.4%) patients AFP, ß-HCG, AFP plus ß-HCG and LDH, respectively. In the cCSIS group, six patients were seminoma and 21 non-seminoma. Treatment consisted of active surveillance, carboplatin-mono AUC7 and BEP (bleomycin, etoposide and cisplatin). No difference between cCSIS and iCSIS with respect to applied chemotherapy was found (p = 0.830). 5-year relapse-free survival was 88.9% and three patients (11%) in the cCSIS group relapsed. All underwent salvage treatment (3xBEP) with no documented death.ConclusionAround 1% of all TGCT were classified as cCSIS patients. Identification of cCSIS is of critical importance to avoid disease progression and relapses by adequate treatment. We report a high heterogeneity of treatment patterns, associated with excellent long-term survival irrespective of the initial treatment approach.

Highlights

Patients and methodsTesticular germ cell tumors (TGCTs) are among the most common solid tumors in men between the age of 15–35 [1, 2]
51 patients with clinical stage IS (CSIS) were identified among the 2616 TGCT patients screened
All of the 16 incorrectly classified CSIS patients were reclassified to CSIA or CSIB, with no reclassification to clinical stage II or III

Summary

Introduction

Patients and methodsTesticular germ cell tumors (TGCTs) are among the most common solid tumors in men between the age of 15–35 [1, 2]. There is a unique subgroup of patients in CSI with inadequately declining, persistently elevated or even increasing TMs after orchiectomy in the presence of negative crosssectional imaging studies, which is characterized as clinical stage IS (CSIS). The European Association of Urology Guidelines on testicular cancer recommend to treat CSIS using three cycles of BEP polychemotherapy (bleomycin, etoposide and cisplatin) [1, 2]. As this standard chemotherapy may involve significant long-term toxicity and as most of the patients with early stage TGCT will survive, the optimal treatment modality for this rare subgroup of patients with only minimal disease burden still needs to be defined

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