Department of Urology and Pediatric Urology, University Hospital of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
UroEvidence at Deutsche Gesellschaft Für Urologie, Berlin, Germany.
World J Urol. 2022 Dec;40(12):2879-2887. doi: 10.1007/s00345-022-04063-7. Epub 2022 Jul 29.
To systematically evaluate evidence on prognostic factors for tumor recurrence in clinical stage I nonseminoma patients other than lymphovascular invasion (LVI).
We performed a systematic literature search in the biomedical databases Medline (via Ovid) and Cochrane Central Register of Controlled Trials (search period January 2010 to February 2021) for full text publications in English and German language, reporting on retro- or prospectively assessed prognostic factors for tumor recurrence in patients with stage I nonseminomatous germ cell tumors.
Our literature search yielded eleven studies reporting on 20 potential prognostic factors. Results are based on cohort studies of mostly moderate to low quality. Five out of eight studies found a significant association of embryonal carcinoma (EC) in the primary tumor with relapse. Among the different risk definitions of embryonal carcinoma (presence, predominance, pure), presence of EC alone seems to be sufficient for prognostification. Interesting results were found for rete testis invasion, predominant yolk sac tumor, T-stage and history of cryptorchidism, but the sparse data situation does not justify their clinical use.
No additional factors that meet the prognostic value of LVI, especially when determined by immunohistochemistry, could be identified through our systematic search. The presence of EC might serve as a second, subordinate prognostic factor for clinical use as the data situation is less abundant than the one of LVI. Further efforts are necessary to optimize the use of these two prognostic factors and to evaluate and validate further potential factors with promising preliminary data.
系统评价除淋巴血管浸润（LVI）以外的临床 I 期非精原细胞瘤患者肿瘤复发的预后因素的证据。
我们在生物医学数据库 Medline（通过 Ovid）和 Cochrane 对照试验中心注册库中进行了系统的文献检索，检索了以英文和德文发表的关于 I 期非精原细胞瘤生殖细胞肿瘤患者肿瘤复发的回顾性或前瞻性评估预后因素的全文出版物。
我们的文献检索结果有 11 项研究报告了 20 个潜在的预后因素。这些结果基于队列研究，其质量大多为中低等。8 项研究中有 5 项发现原发性肿瘤中的胚胎癌（EC）与复发有显著关联。在不同的胚胎癌风险定义（存在、优势、纯）中，仅存在 EC 似乎足以进行预后预测。在睾丸网浸润、优势卵黄囊瘤、T 分期和隐睾病史方面也有有趣的结果，但稀疏的数据情况并不支持其临床应用。
通过系统搜索，没有发现其他具有 LVI 预后价值的因素（尤其是通过免疫组织化学确定时）。EC 的存在可能作为第二个、次要的预后因素用于临床，因为其数据情况比 LVI 的情况要少。需要进一步努力来优化这两个预后因素的使用，并评估和验证具有有希望的初步数据的其他潜在因素。
