Abstract
Non-seminomatous germ cell tumour (NSGCT) is a rare but highly curable malignancy. The literature on the management and outcomes of NSGCT is scarce from India. Here, we report the demography and treatment outcomes of NSGCT treated at our centre. This is a retrospective analysis of testicular and retroperitoneal NSGCT patients treated from March 2011 to December 2019. Patients were staged appropriately with imaging, pre- and post-operative tumour marker. Patients received stage adjusted adjuvant treatment after high inguinal orchiectomy. Patients with advanced disease were risk stratified as per International Germ Cell Cancer Collaborative Group (IGCCCG) classification. A total of 100 patients were treated with a median age of 28 years (Range: 18–51). Primary site was testis in 92 and retroperitoneum in 8 patients. Testicular violation was present in 17 (18%) patients. The stage of the disease was I in 32, II in 19 and III in 49 patients, respectively. IGCCCG risk groups were good in 29 (46%), intermediate in 13 (21%) and poor in 21 (33%) patients. Eleven patients (24%) underwent retroperitoneal lymph node dissection amongst 45 with post-chemotherapy residual disease. After a median follow-up of 26.6 months (range: 2.2–100.7), 3-year event-free survival and overall survival (OS) were 70.7% ± 5.6% and 78.2% ± 5.4%, respectively. S3 tumour marker (p = 0.01) and non-pulmonary visceral metastasis (p < 0.001) emerged as independent poor prognostic factors for OS in multivariate analysis. To conclude, testicular NSGCT has very high cure rate. Two-third patients present with advanced disease and one-third of them had poor risk disease. S3 tumour marker and non-pulmonary visceral metastasis are poor risk factors for OS.
Highlights
Testicular germ cell tumours (TGCTs) constitute 1% of all adult malignancies [1, 2] and are the most common solid tumours in between 18 and 45 years of age [1, 3]
This study aims to analyse the clinicopathologic features, prognostic factors, treatment outcome and treatment-related toxicities in Non-seminomatous germ cell tumour (NSGCT) evaluated and treated at our centre with research questions of – whether surgical aspects improved over time? and did our patients do well in terms of outcome as compared to published real-world literature
A total of 129 patients with a diagnosis of NSGCT were registered between March 2011 and December 2019, out of which 21 did not take any treatment and 8 had mediastinal primary, and were excluded from this analysis
Summary
Testicular germ cell tumours (TGCTs) constitute 1% of all adult malignancies [1, 2] and are the most common solid tumours in between 18 and 45 years of age [1, 3]. Incidence is lowest in African and Asian countries and highest in Scandinavian countries. Incidence of TGCT is increasing in Europe and the United States [2, 4, 5] and becoming more common. India has one of the lowest incidences of TGCTs of 0.5 per 1 lakh men [7]. TGCT comprises seminomatous and non-seminomatous tumours and the latter is more aggressive
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