Abstract

PurposeTo report on the clinical characteristics, outcome, and frequency of peritoneal carcinosis (PC) in patients with advanced germ cell tumors (GCT), a multicenter registry analysis was carried out.MethodsA multicenter registry analysis was conducted by the German Testicular Cancer Study Group (GTCSG) with international collaborators. Data was collected and analyzed retrospectively. Patients were eligible for inclusion if PC was diagnosed either by radiologic or histopathologic finding during the course of disease. Descriptive and explorative statistical analysis was carried out with cancer-specific survival (CSS) as primary study endpoint.ResultsCollaborators from ten GCT expert centers identified 28 GCT (0.77%) patients with PC after screening approximately 3767 GCT patient files and one case was contributed from a cancer registry request. Patients were diagnosed from 1997 to 2019 at a median age of 37 years (interquartile range, 13). Two patients (7%) presented with stage I and 27 patients (93%) with synchronous metastatic disease at first diagnosis. The primary histology was seminoma in seven (27%) and non-seminoma in 21 patients (72%). PC was detected after a median of 15.3 months from primary diagnosis (range 0–177) and two consecutive treatment lines (range 0–5), respectively. The median CSS from the time of detection of PC was 10.5 months (95%Confidence Interval 0.47–1.30) associated with an overall 2-year CSS rate of 30%.ConclusionPC represents a rare tumor manifestation in GCT patients and was primarily associated with the occurrence of advanced cisplatin-refractory disease conferring to a dismal prognosis.

Highlights

  • Testicular germ cell tumors (GCTs) are the most common solid organ malignancy among young men aged between 15 and 35 years [1]

  • Peritoneal carcinosis (PC) in GCT patients was described by case reports and small case series only, revealing merely little data concerning the frequency, potential causes of development and impact on the patient’s outcome [8,9,10,11,12]

  • The aim of this study was to present sufficient data to adequately describe the patient characteristics, outcome, approximate frequency and potential causes concerning the route of dissemination of peritoneal carcinosis (PC) in GCT patients

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Summary

Introduction

Testicular germ cell tumors (GCTs) are the most common solid organ malignancy among young men aged between 15 and 35 years [1]. As four of the patients received retroperitoneal lymph node dissection (RPLND) prior to the detection of PC, the authors hypothesized that RPLND may have caused a route of tumor extension from a lymphatic leakage during surgery which promoted consecutive PC development [8]. This hypothesis was, shared by two other case reports, presenting single patient cases with GCT and PC development after RPLND or lymph node biopsy [9, 10].

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