Paffenholz Pia, Seelemeyer F, Gößmann Ruben, von Brandenstein Melanie, Pfister David, Heidenreich Axel
Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University Hospital Cologne, Cologne, Germany; Center for Integrated Oncology (CIO) Köln-Bonn, Cologne, Germany.
Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University Hospital Cologne, Cologne, Germany.
Clin Genitourin Cancer. 2025 Aug;23(4):102347. doi: 10.1016/j.clgc.2025.102347. Epub 2025 Apr 16.
As the characteristics and outcome associated with relapse in seminomatous testicular germ cell tumors (STGCT) are still unclear, this study aims at evaluating the differences between very early relapse (VER) and later relapse (LR) in this cohort of patients.
This retrospective analysis included 459 patients with STGCT treated from 2000 to 2024, analysing patient characteristics with nonparametric statistics as well as follow-up using Kaplan Meier analyses. VER was defined as tumour recurrence < 12 months after successful treatment.
About 94 (20%) patients relapsed during a median follow-up of 19 months [IQR 2-68]. De novo metastatic patients with VER (n = 38, 40%) showed a significantly higher number of clinical stages 2C-3 disease (21% vs. 4%, P = .007), M-stage (P = .009) at diagnosis as well as a higher HCG level (P = .030) and LDH levels (P < .001; >2x ULN P = .039) at start of chemotherapy compared to patients with LR (n = 56; 60%). Initial treatment did not significantly differ between VER and LR (P = .199). VER after initial metastatic disease was associated with a significantly reduced overall survival compared to LR (P = .046), however not after de novo stage I. Our study is limited by its retrospective design.
Relapse in seminoma occurred in 20% of all patients. In the initial metastatic stage, VER was associated with a higher metastatic burden at diagnosis compared to LR, leading to a reduced overall survival in VER. Consequently, treating physicians should be aware of these patients portending a worse prognosis, potentially discussing an early intensification of systemic treatment.
由于精原细胞瘤性睾丸生殖细胞肿瘤（STGCT）复发的特征和结果仍不明确，本研究旨在评估该队列患者中极早期复发（VER）和晚期复发（LR）之间的差异。
这项回顾性分析纳入了2000年至2024年接受治疗的459例STGCT患者，使用非参数统计分析患者特征，并采用Kaplan Meier分析进行随访。VER定义为成功治疗后<12个月出现肿瘤复发。
在中位随访19个月[IQR 2 - 68]期间，约94例（20%）患者复发。VER的新发转移患者（n = 38，40%）在诊断时临床分期为2C - 3期疾病的数量显著更多（21%对4%，P = 0.007），M分期（P = 0.009），以及化疗开始时HCG水平更高（P = 0.030）和LDH水平更高（P < 0.001；>2倍ULN，P = 0.039），与LR患者（n = 56；60%）相比。VER和LR之间的初始治疗无显著差异（P = 0.199）。初始转移性疾病后的VER与LR相比，总生存期显著降低（P = 0.046），但I期新发患者后无此情况。我们的研究受其回顾性设计的限制。
所有患者中有20%发生精原细胞瘤复发。在初始转移阶段，与LR相比，VER在诊断时转移负担更高，导致VER的总生存期降低。因此，治疗医生应意识到这些患者预后较差，可能需要讨论早期强化全身治疗。
