Pathologic findings and clinical outcomes in patients who required neoadjuvant chemotherapy before orchiectomy for testicular germ cell tumors

Abstract

Treatment for testicular germ cell tumors (GCTs) includes orchiectomy followed potentially by adjuvant chemotherapy. Rarely, patients with testicular GCT have significant metastatic disease, requiring neoadjuvant chemotherapy before orchiectomy. We investigated the pathologic findings and clinical outcomes in patients who underwent neoadjuvant chemotherapy before orchiectomy for testicular GCT. We identified 45 patients with a mean age of 34 years (range, 15-66 years). Orchiectomy findings included pure teratoma (n=23), no residual tumor (n=13), mixed GCT (n=5), pure seminoma (n=2), pure yolk sac tumor (YST) (n=1), and pure germ cell neoplasia in situ(n=1). Cancer-specific death occurred in 4 of 45patients (9%). Seventeen of 45patients (38%) experienced disease progression after initial chemotherapy. Eleven of 45patients (24%) underwent salvage chemotherapy. Retroperitoneal lymph nodes were the most common site of metastases followed by lung. Overall, the most common type of tumor found in metastases was YST (12/45, 27%) and teratoma (11/45, 24%). Of the 23 patients with residual pure teratoma in the testis, 9(39%) had disease recurrence and/or progression and 3(13%) died. In the metastases of these patients, nonteratoma GCT was found in 17 of 23patients (74%). Nine of 45patients (20%) had residual testicular nonteratoma GCT. Of the 9 patients, 6 (67%) had disease recurrence and/or progression and 1 (11%) died. Patients with no residual testicular disease (ypT0) had a lower risk of disease recurrence and/or progression (P=.046) and had no deaths. In patients who have undergone neoadjuvant chemotherapy for testicular GCT, the orchiectomy histology often does not correlate with the histology of metastases. No residual testicular disease indicates a better prognosis in these patients.