Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
Clin Genitourin Cancer. 2024 Jun;22(3):102089. doi: 10.1016/j.clgc.2024.102089. Epub 2024 Apr 4.
We aimed to evaluate the status of spermatogenesis detected by histological examination of non-tumoral testicular tissues in tumor bearing testis and its association with advanced stage disease.
We retrospectively reviewed patients with testicular germ cell tumors (TGCTs) that undergone radical orchiectomy. All non-tumoral areas of the orchiectomy specimens were examined for the status of spermatogenesis. Patients were divided into two groups as localized (stage I) and metastatic (stage II-III) disease and analyzed separately for seminomatous (SGCT) and nonseminomatous germ cell tumors (NSGCT).
Four hundred fifty-four patients were included in our final analysis. Of those, 195 patients had SGCT, and 259 patients had NSGCT. Three hundred and six patients had localized disease at the time of diagnosis. Median (Q1-Q3) age was 31 (26 - 38) years and 102 (22.5%) patients had normal spermatogenesis, 177 (39.0%) patients had hypospermatogenesis and 175 (38.5%) patients had no mature spermatozoa. On multivariate logistic regression analysis, embryonal carcinoma >50% (1.944, 95 %CI 1.054-3.585, P = .033) and spermatogenesis status (2.796 95% CI 1.251-6.250, P = .012 for hypospermatogenesis, and 3.907, 95% CI 1.692-9.021, P = .001 for absence of mature spermatozoa) were independently associated with metastatic NSGCT. However, there was not any variables significantly associated with metastatic SGCT on multivariate logistic regression analysis.
Our study demonstrated that only 22.5% of patients with TGCTs had normal spermatogenesis in tumor bearing testis. Impaired spermatogenesis (hypospermatogenesis or no mature spermatozoa) and predominant embryonal carcinoma are associated with advanced stage NSGCT.
本研究旨在评估肿瘤睾丸中非肿瘤组织的组织学检查中精子发生的状态，并分析其与晚期疾病的关系。
我们回顾性分析了接受根治性睾丸切除术的睾丸生殖细胞肿瘤（TGCT）患者。所有睾丸切除术标本的非肿瘤区域均进行精子发生状态检查。患者分为局限性（I 期）和转移性（II-III 期）疾病两组，并分别对精原细胞瘤（SGCT）和非精原细胞瘤生殖细胞肿瘤（NSGCT）进行分析。
我们的最终分析共纳入 454 例患者。其中 195 例为 SGCT，259 例为 NSGCT。306 例患者在诊断时为局限性疾病。中位（Q1-Q3）年龄为 31 岁（26-38 岁），102 例（22.5%）患者精子发生正常，177 例（39.0%）患者存在少精子症，175 例（38.5%）患者无成熟精子。多变量逻辑回归分析显示，胚胎癌＞50%（1.944，95%CI 1.054-3.585，P=0.033）和精子发生状态（少精子症为 2.796，95%CI 1.251-6.250，P=0.012；无成熟精子症为 3.907，95%CI 1.692-9.021，P=0.001）与转移性 NSGCT 独立相关。然而，多变量逻辑回归分析显示，没有任何变量与转移性 SGCT 显著相关。
我们的研究表明，只有 22.5%的 TGCT 患者在肿瘤睾丸中有正常的精子发生。精子发生受损（少精子症或无成熟精子）和胚胎癌为主与晚期 NSGCT 相关。
