Department of Urology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Urology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.
Urol Oncol. 2021 Dec;39(12):838.e15-838.e20. doi: 10.1016/j.urolonc.2021.08.004. Epub 2021 Sep 2.
To assess if clinical, pathological, and spermatogenesis factors are associated with clinical staging in patients with testicular germ cell tumors.
We retrospectively reviewed the pathology reports and slides from 267 men who underwent radical orchiectomy for testicular cancer at our institution during 1998-2019. Histologic slides were reviewed and the presence of mature spermatozoa was documented. Clinical, laboratory and radiographic characteristics were recorded. Logistic regression analyses were used to identify factors associated with advanced disease stage at diagnosis.
Of 267 male patients, 115 (43%) patients had testicular non-seminomatous germ cell tumors (NSGCT) and 152 (57%) seminomatous germ cell tumors (SGCT). Among NSGCT patients, those presenting with metastatic disease had a higher proportion of predominant (>50%) embryonal carcinoma (64% vs. 43%, respectively, P = 0.03), and lymphovascular invasion (45.8% vs. 26.6%, respectively, P = 0.03) than non-metastatic patients. Spermatogenesis was observed in 56/65 (86.2%) and 36/49 (73.5%) of non-metastatic and metastatic NSGCT patients, respectively (P = 0.09). On semen analysis, severe oligospermia (<5 million/ml) was more common in metastatic than in non-metastatic NSGCT (26.5% vs. 8.3%, respectively, P = 0.04). On multivariate analysis, predominant embryonal carcinoma and lack of spermatogenesis in pathological specimens were associated with metastatic disease.
The absence of spermatogenesis and a high proportion of embryonal carcinoma was associated with advanced disease in patients with NSGCT. Whether it may also translate as a predictor of oncologic outcome needs further evaluation.
评估临床、病理和生精因素是否与睾丸生殖细胞肿瘤患者的临床分期相关。
我们回顾性分析了 1998 年至 2019 年期间在我院接受根治性睾丸切除术的 267 名男性睾丸癌患者的病理报告和切片。评估了组织学切片，记录了成熟精子的存在情况。记录了临床、实验室和影像学特征。采用逻辑回归分析确定与诊断时晚期疾病相关的因素。
在 267 名男性患者中，115 名（43%）患者患有非精原细胞瘤性睾丸生殖细胞肿瘤（NSGCT），152 名（57%）患者患有精原细胞瘤性睾丸生殖细胞肿瘤（SGCT）。在 NSGCT 患者中，转移性疾病患者的胚胎癌（64%比 43%，P=0.03）和血管淋巴管侵犯（45.8%比 26.6%，P=0.03）的比例较高。非转移性患者。在非转移性和转移性 NSGCT 患者中，分别有 56/65（86.2%）和 36/49（73.5%）的患者观察到生精（P=0.09）。在精液分析中，转移性 NSGCT 患者的严重少精子症（<500 万/ml）比非转移性 NSGCT 患者更常见（分别为 26.5%和 8.3%，P=0.04）。多变量分析显示，病理标本中胚胎癌为主和无生精与转移性疾病相关。
在 NSGCT 患者中，缺乏生精和高比例的胚胎癌与疾病的进展相关。它是否也可以作为肿瘤学结果的预测因素，还需要进一步评估。
