Is a risk-adapted therapy possible in clinical stage i non-seminomatous testicular germ cell tumors?

Optimal management of patients with clinical stage I non-seminomatous testicular germ cell tumors remains highly controversial, since all available therapeutic options, such as nerve-sparing retroperitoneal lymphadenectomy, primary chemotherapy and surveillance, lead to the same high cure rate of 98%. Since the majority of patients are diagnosed and treated at a young age, quality of life issues have assumed great importance for both the patient and the urologist. The development of reliable and reproducible prognostic risk factors to define low and high risk groups for occult retropertoneal metastatic disease may help clinicians to make more rational decisions about whether retroperitoneal lymph-node dissection, primary chemotherapy or surveillance should follow initial orchiectomy. As of 1997, the most clinically useful prognostic risk factors are the percentage of embryonal carcinoma and the presence or absence of vascular invasion by tumor cells in the primary tumor. Assessment of both parameters enables the definition of low and high risk groups for metastatic disease with a more than 90% accuracy. Ongoing work with DNA cytometry, proliferation markers, oncogenes, tumor suppressor genes, proteases and cellular adhesion molecules may allow further stratification of patients as to their likelihood of developing occult metastases in the future. Currently, however, none of the molecular markers is superior to meticulous quantitative histopathologic analysis of the primary tumor, nor do they add additional prognostic information on vascular invasion and percentage of embryonal carcinoma. © Georg Thieme Verlag Stuttgart · New York.

Duke Scholars

Author Judd Wendell Moul Urology