Risk Stratification of Pubertal Children and Postpubertal Adolescents with Clinical Stage I Testicular Nonseminomatous Germ Cell Tumors

Abstract

Approximately half of pubertal children and postpubertal adolescents with high risk clinical stage I testicular germ cell tumors harbor occult metastatic disease. These results may be useful when discussing prognosis and treatment with patients and families.

Characteristics of testicular tumors in prepubertal children (age 5–12 years)

“…In prepubertal boys younger than 5 years, testicular tumors are different from adult neoplasms. Germ cell tumors are less common than in adults and account for 60-77% of the testicular tumors [3][4][5][6] [7].…”

Current urologic care for testicular germ cell tumors in pediatric and adolescent patients

“…Even patients with high-risk pathologic features on the orchiectomy specimen (440%-50% EC histology or lymphovascular invasion [LVI]) can consider surveillance. In a series of adolescents with Clinical Stage I TGCT 58.3% of patients with "high-risk" pathology relapsed, vs. 0% of the patients without "high-risk" features [30]. Similarly, in a study of 248 men in New Zealand with Clinical Stage I disease, overall 28% relapsed: 46% with LVI relapsed vs. 17% without LVI.…”

“…EC may also produce AFP. Overall, EC is an aggressive histology frequently associated with metastases and has been used for risk stratification of Clinical Stage I disease in both adolescents and adults [29,30].…”

Adolescent and Young Adult Testicular Germ Cell Tumors: Special Considerations

“…In the adult population, the identification of high-risk features for harboring of occult metastases—lymphovascular invasion and an increasing component of embryonal carcinoma for NSGCT [ 35 ] and size > 4 cm and rete testis invasion for seminoma [ 36 ]—has allowed a risk-stratified treatment approach to be employed [ 34 ]. Cost et al [ 37 ] reviewed 23 patients aged 7–21 years and found that about half of all patients had high-risk features (≥40% embryonal carcinoma or lymphovascular invasion), and almost 60% with high-risk features harbored occult metastatic disease. No patients without high-risk features had metastatic disease.…”