Prognostic factors in patients with clinical stage I nonseminoma—beyond lymphovascular invasion: a systematic review

TY - JOUR

T1 - Prognostic factors in patients with clinical stage I nonseminoma—beyond lymphovascular invasion: a systematic review

AU - Zengerling, Friedemann

AU - Beyersdorff, Dirk

AU - Busch, Jonas

AU - Heinzelbecker, Julia

AU - Pfister, David

AU - Ruf, Christian

AU - Winter, Christian

AU - Albers, Peter

AU - Kliesch, Sabine

AU - Schmidt, Stefanie

PY - 2022/12

Y1 - 2022/12

N2 - OBJECTIVE: To systematically evaluate evidence on prognostic factors for tumor recurrence in clinical stage I nonseminoma patients other than lymphovascular invasion (LVI).METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.

AB - OBJECTIVE: To systematically evaluate evidence on prognostic factors for tumor recurrence in clinical stage I nonseminoma patients other than lymphovascular invasion (LVI).METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.

KW - Carcinoma, Embryonal/pathology

KW - Humans

KW - Male

KW - Neoplasm Invasiveness/pathology

KW - Neoplasm Recurrence, Local/pathology

KW - Neoplasm Staging

KW - Prognosis

KW - Testicular Neoplasms/pathology

U2 - 10.1007/s00345-022-04063-7

DO - 10.1007/s00345-022-04063-7

M3 - SCORING: Journal article

C2 - 35906286

VL - 40

SP - 2879

EP - 2887

JO - WORLD J UROL

JF - WORLD J UROL

SN - 0724-4983

IS - 12

ER -