Department of Radiation Oncology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA.
Med Oncol. 2018 Jan 31;35(3):21. doi: 10.1007/s12032-018-1090-y.
The frequency of co-occurrence between germ cell tumor (GCT) components in non-seminomatous germ cell tumor (NSGCT) orchiectomy specimens and their correlation with histologic findings in subsequent retroperitoneal lymph node dissection (RPLND) specimens have not been well characterized. The objective of the study was to report the first detailed clinicopathologic analysis of NSGCT orchiectomy and RPLND samples to determine the likelihood and agreement of the co-occurrence of GCT components. A total of 118 consecutive patients with NSGCT treated between 1988 and 2012 who underwent both orchiectomy and RPLND at a single academic tertiary care center were analyzed. Statistical analysis of co-occurrence likelihood and agreement of GCT components was performed, both within and between orchiectomy and RPLND specimens. Embryonal carcinoma was the most frequent component present in orchiectomy specimens, and there were multiple significant associations between orchiectomy GCT components; seminoma occurred less frequently with embryonal carcinoma (OR 0.29 [95% confidence interval (CI) 0.11-0.75]; p < 0.01), and teratoma more frequently occurred with choriocarcinoma (OR 9.64 [95% CI 1.22-76.12]; p = 0.01). Presence of teratoma in the orchiectomy specimen predicted for a fourfold increase in distant metastasis on multivariate analysis (HR 4.92 [1.14-18.9]; p = 0.02). The only significant association of co-occurrence in the RPLND specimen was between embryonal carcinoma and teratoma (OR 0.01 [95% CI 0-0.07]; p < 0.001), where it was significantly less likely for them to occur together. Our findings are limited by their retrospective nature. The co-occurrence of GCT components within orchiectomy specimens does not appear to be a completely random process. However, there is less agreement and more randomness between the occurrence of the GCT components in matched orchiectomy and RPLND samples. In this report, we look at the co-occurrence of different GCT components within matched orchiectomy and RPLND pathology specimens and show that co-occurrence is not a completely random process.
在非精原细胞瘤生殖细胞肿瘤（NSGCT）睾丸切除术标本中，生殖细胞肿瘤（GCT）成分的同时出现频率及其与随后的腹膜后淋巴结清扫术（RPLND）标本中的组织学发现的相关性尚未得到很好的描述。本研究的目的是报告首例详细的 NSGCT 睾丸切除术和 RPLND 样本的临床病理分析，以确定 GCT 成分同时出现的可能性和一致性。对 1988 年至 2012 年间在一家学术性三级护理中心接受睾丸切除术和 RPLND 的 118 例连续 NSGCT 患者进行了分析。对睾丸切除术和 RPLND 标本内和之间 GCT 成分同时出现的可能性和一致性进行了统计学分析。在睾丸切除术标本中，胚胎癌是最常见的成分，并且在睾丸切除术 GCT 成分之间存在多个显著关联；精原细胞瘤与胚胎癌的发生频率较低（OR 0.29 [95%置信区间（CI）0.11-0.75]；p<0.01），而畸胎瘤与绒癌的发生频率较高（OR 9.64 [95%CI 1.22-76.12]；p=0.01）。在多变量分析中，睾丸切除术标本中存在畸胎瘤预测远处转移的风险增加四倍（HR 4.92 [1.14-18.9]；p=0.02）。RPLND 标本中唯一显著的同时出现关联是胚胎癌和畸胎瘤（OR 0.01 [95%CI 0-0.07]；p<0.001），它们同时出现的可能性明显较低。我们的发现受到其回顾性的限制。睾丸切除术标本中 GCT 成分的同时出现似乎不是一个完全随机的过程。然而，在匹配的睾丸切除术和 RPLND 样本中，GCT 成分的出现之间的一致性较低，随机性较大。在本报告中，我们观察了匹配的睾丸切除术和 RPLND 病理学标本中不同 GCT 成分的同时出现，并表明同时出现不是一个完全随机的过程。
