Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University Hospital Cologne, Cologne, Germany.
Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany.
Urol Int. 2022;106(10):1061-1067. doi: 10.1159/000515715. Epub 2021 Jun 15.
The impact of teratomatous elements in orchiectomy specimens of metastasized testicular germ cell tumors (TGCT) regarding oncological outcome is still unclear.
We performed a retrospective analysis including 146 patients with metastasized TGCT analysing patient characteristics.
Twenty-six (18%) of all patients showed teratomatous elements in the orchiectomy specimens. TGCT with teratomatous elements showed a significantly higher frequency of clinical-stage 2C-3 disease (73 vs. 49%, p = 0.031), visceral metastases (58 vs. 32%, p = 0.015), and poor prognosis (p = 0.011) than TGCT without teratomatous elements. Teratoma-containing TGCT revealed a significantly higher rate of post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND, 54 vs. 32%, p = 0.041), with teratomatous elements being more often present in the PC-RPLND specimens (43 vs. 11%, p = 0.020) than nonteratoma-containing primaries. In the Kaplan-Meier estimates, the presence of teratomatous elements in orchiectomy specimens was associated with a significantly reduced relapse-free survival (RFS) (p = 0.049) during a median follow-up of 36 months (10-115.5).
The presence of teratomatous elements in orchiectomy specimens is associated with an advanced tumor stage, worse treatment response as well as a reduced RFS in metastasized TGCT. Consequently, the presence of teratomatous elements might act as a reliable stratification tool for treatment decision in TGCT patients.
在转移性睾丸生殖细胞瘤（TGCT）的睾丸切除术标本中，畸胎瘤成分对肿瘤学结局的影响尚不清楚。
我们对 146 例转移性 TGCT 患者进行了回顾性分析，分析了患者的特征。
所有患者中有 26 例（18%）在睾丸切除术标本中存在畸胎瘤成分。有畸胎瘤成分的 TGCT 患者临床分期 2C-3 期疾病的发生率明显更高（73%比 49%，p = 0.031），内脏转移的发生率（58%比 32%，p = 0.015），以及预后较差（p = 0.011）。含畸胎瘤的 TGCT 患者接受化疗后腹膜后淋巴结清扫术（PC-RPLND）的比例明显更高（54%比 32%，p = 0.041），且 PC-RPLND 标本中畸胎瘤成分的存在率也更高（43%比 11%，p = 0.020）。在 Kaplan-Meier 估计中，睾丸切除术标本中存在畸胎瘤成分与无复发生存率（RFS）显著降低相关（p = 0.049），中位随访 36 个月（10-115.5）。
睾丸切除术标本中存在畸胎瘤成分与肿瘤分期较晚、治疗反应较差以及转移性 TGCT 的 RFS 降低有关。因此，畸胎瘤成分的存在可能是 TGCT 患者治疗决策的可靠分层工具。
