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Vascular invasion as a prognosticator of metastatic disease in nonseminomatous germ cell tumors of the testis. Importance in “surveillance only” protocols
Author(s) -
Moriyama Nobuo,
Daly James J.,
Keating Michael A.,
Lin ChiWei,
Prout George R.
Publication year - 1985
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19851115)56:10<2492::aid-cncr2820561027>3.0.co;2-r
Subject(s) - medicine , germ cell tumors , germ cell , vascular invasion , oncology , metastasis , pathology , cancer , chemotherapy , biology , biochemistry , gene
Forty‐five nonseminomatous germ cell carcinomas of the testis were evaluated retrospectively to define the biologic features associated with the occurrence of metastatic disease. A statistical analysis of several pertinent clinical and pathologic factors was performed. The factors evaluated included: duration of symptoms before diagnosis, serum level of alpha‐fetoprotein, serum or urinary level of human chorionic gonadotropin, testicular weight, extent of local tumor (pathologic T stage), and vascular invasion at the primary site. In each case, metastases were documented by a retroperitoneal node dissection, other biopsies, or by chest films. In 29 tumors with vascular invasion, 25 patients were seen with metastatic disease. In 16 tumors without vascular invasion, 3 patients demonstrated metastasis. The presence or absence of vascular invasion was strongly correlated with concomitant lymph node involvement or subsequent appearance of other metastatic disease (chi‐square = 17.19). Additionally, vascular invasion in bifactoral analysis with tumor size and pathologic T stage proved a significant prognosticator even in low‐staged (chi‐square = 8.48) and small tumors (chi‐square = 8.13). The implications of these findings, both as an adjunct to the staging of nonseminomatous germ cell tumors and in the management of clinical Stage I lesions, are discussed.