Department of Urology and Pediatric Urology, University Medical Center Mainz, University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
Department of Urology, Bundeswehrkrankenhaus Ulm, Ulm, Germany.
World J Urol. 2022 Feb;40(2):327-334. doi: 10.1007/s00345-021-03889-x. Epub 2021 Dec 2.
Clinical stage I (CSI) testicular germ cell tumors (TGCT) represents disease confined to the testis without metastasis and CSIS is defined as persistently elevated tumor markers (TM) after orchiectomy, indicating subclinical metastatic disease. This study aims at assessing clinical characteristics and oncological outcome in CSIS.
Data from five tertiary referring centers in Germany were screened. We defined correct classification of CSIS according to EAU guidelines. TM levels, treatment and relapse-free survival were assessed and differences between predefined groups (chemotherapy, correct/incorrect CSIS) were analyzed with Fisher's exact and Chi-square test.
Out of 2616 TGCT patients, 43 (1.6%) were CSIS. Thereof, 27 were correctly classified (cCSIS, 1.03%) and 16 incorrectly classified (iCSIS). TMs that defined cCSIS were in 12 (44.4%), 10 (37%), 3 (11.1%) and 2 (7.4%) patients AFP, ß-HCG, AFP plus ß-HCG and LDH, respectively. In the cCSIS group, six patients were seminoma and 21 non-seminoma. Treatment consisted of active surveillance, carboplatin-mono AUC7 and BEP (bleomycin, etoposide and cisplatin). No difference between cCSIS and iCSIS with respect to applied chemotherapy was found (p = 0.830). 5-year relapse-free survival was 88.9% and three patients (11%) in the cCSIS group relapsed. All underwent salvage treatment (3xBEP) with no documented death.
Around 1% of all TGCT were classified as cCSIS patients. Identification of cCSIS is of critical importance to avoid disease progression and relapses by adequate treatment. We report a high heterogeneity of treatment patterns, associated with excellent long-term survival irrespective of the initial treatment approach.
临床 I 期（CSI）睾丸生殖细胞肿瘤（TGCT）表示疾病局限于睾丸且无转移，CSIS 定义为睾丸切除术后持续升高的肿瘤标志物（TM），表明存在亚临床转移性疾病。本研究旨在评估 CSIS 的临床特征和肿瘤学结局。
筛选了来自德国五家三级转诊中心的数据。我们根据 EAU 指南定义 CSIS 的正确分类。评估 TM 水平、治疗和无复发生存率，并使用 Fisher 精确检验和卡方检验分析预定义组（化疗、正确/不正确 CSIS）之间的差异。
在 2616 例 TGCT 患者中，有 43 例（1.6%）为 CSIS。其中，27 例被正确分类（cCSIS，1.03%），16 例被错误分类（iCSIS）。定义 cCSIS 的 TM 分别在 12（44.4%）、10（37%）、3（11.1%）和 2（7.4%）例患者中为 AFP、ß-HCG、AFP 加ß-HCG 和 LDH。在 cCSIS 组中，有 6 例为精原细胞瘤，21 例为非精原细胞瘤。治疗包括主动监测、卡铂单 AUC7 和 BEP（博来霉素、依托泊苷和顺铂）。在应用化疗方面，cCSIS 和 iCSIS 之间无差异（p=0.830）。5 年无复发生存率为 88.9%，cCSIS 组中有 3 例（11%）患者复发。所有患者均接受挽救治疗（3xBEP），无死亡记录。
大约 1%的所有 TGCT 被归类为 cCSIS 患者。识别 cCSIS 对于通过适当治疗避免疾病进展和复发至关重要。我们报告了治疗模式的高度异质性，但无论初始治疗方法如何，长期生存均非常好。
