Departments of Urology and Oncology, the James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
University of Texas Southwestern Medical School, Dallas, TX, USA.
J Pediatr Urol. 2022 Aug;18(4):505-511. doi: 10.1016/j.jpurol.2022.04.022. Epub 2022 May 7.
Patients with clinical stage I (CS I: cN0M0) testicular germ cell tumors (TGCT) exhibit favorable oncologic outcomes. While prognostic features can help inform treatment in adults with CS I TGCT, we lack reliable means to predict relapse among pediatric and adolescent patients.
We sought to identify predictors of relapse in children with CS I TGCT.
We performed a pooled post hoc analysis on pediatric and adolescent AJCC CS I TGCT patients enrolled in 3 prospective trials: INT-0097 (phase II), INT-0106 (phase III), and AGCT0132 (phase III). Pathology was centrally reviewed. Patient demographics, pT stage, serum tumor markers, margin status, histology, relapse, and survival were compiled. Cox regression analyses were used to identify predictors of events, defined as relapse, secondary malignant neoplasm, or death.
106 patients were identified with outcomes data available. Most patients were pT1-2 stage. Among patients with evaluable histopathology, yolk sac tumor elements were present in all patients and lymphovascular invasion in 51% of patients. Over a median follow-up of 56 months, no patients died, and 25 patients (24%) experienced an event (median event-free survival not reached). Independent predictors of events on multivariable analysis included age ≥12 years at diagnosis (HR 8.87, p < 0.001) and higher pT stage (pT2 HR 7.31, p = 0.0017; pT3 HR 13.5, p = 0.0043).
Although our study population reflects the largest pooled prospective cohort of CS I pediatric and adolescent TGCT to our knowledge, the relatively low event rate limits our multivariable analysis, and longer follow-up duration would help further characterize the natural history of these patients. Centralized pathologic review was also unable to be performed for several patients.
Pediatric and adolescent CS I TGCT patients exhibit remarkable 5-year survival. Using combined data from multiple prospective trials, our study identifies clinicopathologic features that predict relapse and inform personalized treatment for these patients by potentially guiding surveillance versus adjuvant treatment strategies.
临床 I 期（CS I：cN0M0）睾丸生殖细胞肿瘤（TGCT）患者表现出良好的肿瘤学预后。虽然预后因素有助于为 CS I TGCT 成人患者提供治疗依据，但我们缺乏可靠的方法来预测儿科和青少年患者的复发。
我们旨在确定 CS I TGCT 儿科和青少年患者复发的预测因素。
我们对 3 项前瞻性试验（INT-0097[二期]、INT-0106[三期]和 AGCT0132[三期]）中入组的儿科和青少年 AJCC CS I TGCT 患者进行了汇总事后分析。对病理学进行了中心审查。收集了患者的人口统计学、pT 分期、血清肿瘤标志物、切缘状态、组织学、复发和生存情况。使用 Cox 回归分析确定事件的预测因素，事件定义为复发、继发恶性肿瘤或死亡。
确定了 106 例有结局数据的患者。大多数患者为 pT1-2 期。在具有可评估组织病理学的患者中，所有患者均存在卵黄囊瘤成分，51%的患者存在血管淋巴管浸润。中位随访 56 个月，无患者死亡，25 例（24%）患者发生事件（中位无事件生存未达到）。多变量分析的独立事件预测因素包括诊断时年龄≥12 岁（HR 8.87，p<0.001）和较高的 pT 分期（pT2 HR 7.31，p=0.0017；pT3 HR 13.5，p=0.0043）。
尽管我们的研究人群反映了我们所知的最大的 CS I 儿科和青少年 TGCT 前瞻性队列汇总，但相对较低的事件率限制了我们的多变量分析，更长的随访时间将有助于进一步描述这些患者的自然病史。对一些患者也无法进行集中的病理审查。
CS I TGCT 儿科和青少年患者表现出显著的 5 年生存率。通过使用多个前瞻性试验的联合数据，我们的研究确定了预测复发的临床病理特征，并通过潜在地指导监测与辅助治疗策略，为这些患者提供个性化治疗依据。
