+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Risk factors for relapse in clinical stage I nonseminomatous testicular germ cell tumors: results of the German Testicular Cancer Study Group Trial



Risk factors for relapse in clinical stage I nonseminomatous testicular germ cell tumors: results of the German Testicular Cancer Study Group Trial



Journal of Clinical Oncology 21(8): 1505-1512



To prospectively assess potential risk factors for relapse in clinical stage I nonseminomatous germ cell tumors of the testis (CS I NSGCT). From September 1996 to May 2002, 200 patients with CS I NSGCT were prospectively assigned to retroperitoneal lymph node dissection (RPLND), and risk factor assessment was performed within a multicenter protocol. One hundred sixty-five patients had an adequate minimum follow-up of 12 months (mean, 34.5 months) or had pathologic stage II. Pathologic stage II disease was found in 27.9% of patients. Only 0.6% of patients relapsed in the retroperitoneum after confirmation of pathologic stage I disease. With reference pathology, vascular invasion (VI) was most predictive of stage in multifactorial analysis (accuracy, 65.1%). However, the positive predictive value (PPV) of VI to predict patients who have metastatic disease or relapse during follow-up was only 52.7%. With absent VI, low-risk patients had a negative predictive value (NPV) of 76.9%. With a combination of several risk factors, the PPV increased to 63.6% and the negative predictive value increased to 86.5%. Even with an optimal combination of prognostic factors and reference pathology, more than one third of patients predicted to have pathologic stage II or relapse during follow-up will not harbor metastatic disease and, therefore, would be overtreated with adjuvant therapy. However, patients at low risk may be predicted at an 86.5% level, and thus, surveillance in highly compliant patients would be a valuable option. For high-risk patients, further reduction of adjuvant treatment is necessary.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 050223521

Download citation: RISBibTeXText

PMID: 12697874

DOI: 10.1200/jco.2003.07.169


Related references

Risk factors for relapse in stage I non-seminomatous germ-cell tumors: preliminary results of the German Multicenter Trial. German Testicular Cancer Study Group. International Journal of Cancer 83(6): 828-830, 1999

Randomized phase III trial comparing retroperitoneal lymph node dissection with one course of bleomycin and etoposide plus cisplatin chemotherapy in the adjuvant treatment of clinical stage I Nonseminomatous testicular germ cell tumors: AUO trial AH 01/94 by the German Testicular Cancer Study Group. Journal of Clinical Oncology 26(18): 2966-2972, 2008

Risk factors for relapse in patients with clinical stage I testicular nonseminomatous germ cell tumors. Medical Oncology 30(1): 494, 2013

The use of dose-intensified chemotherapy in the treatment of metastatic nonseminomatous testicular germ cell tumors. German Testicular Cancer Study Group. Seminars in Oncology 25(2 Suppl 4): 24-32; Discussion 45-8, 1998

Prediction of occult metastases in patients with clinical stage I non-seminomatous germ cell tumors First results of the prospective multicenter trial of the German Testicular Cancer Study Group. Journal of Urology 165(5 Suppl.): 152, 2001

Long-term results following adjuvant chemotherapy in patients with clinical stage I testicular nonseminomatous malignant germ cell tumors with high risk factors. Journal of Urology 161(4): 1148-1152, 1999

Complications of primary nerve sparing retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell tumors of the testis: experience of the German Testicular Cancer Study Group. Journal of Urology 169(5): 1710-1714, 2003

Adjuvant chemotherapy for high-risk clinical stage I nonseminomatous testicular germ cell cancer: long-term results of a prospective trial. Journal of Clinical Oncology 14(2): 441-448, 1996

Prognostic factors in clinical stage I nonseminomatous germ cell tumors of the testis: multivariate analysis of a prospective multicenter study. Swedish-Norwegian Testicular Cancer Group. Journal of Clinical Oncology 8(3): 509-518, 1990

Is retroperitoneal lymph node dissection alone optimal or sufficient therapy for clinical stage I nonseminomatous germ cell testicular tumors at high risk for relapse?. Journal of Urology 159(5 Suppl. ): 49, 1998

Prognostic factors in clinical stage I nonseminomatous germ cell testicular tumors: rationale for different risk-adapted treatment. European Urology 33(6): 562-566, 1998

One course of adjuvant PEB chemotherapy versus retroperitoneal lymph node dissection in patients with stage I non-seminomatous germ-cell tumors (NSGCT): Results of the German Prospective Multicenter Trial (Association of Urological Oncology [AUO]/German Testicular Cancer Study Group [GTCSG] Trial 01-94). Journal of Clinical Oncology 24(18_Suppl): 4512-4512, 2016

Serum lactate dehydrogenase isoenzyme 1 and relapse in patients with nonseminomatous testicular germ cell tumors clinical stage I. Acta Oncologica 40(4): 536-540, 2001

Complications Of Post-Chemotherapy Retroperitoneal Lymph Node Dissection (Pcrplnd) In Advanced Nonseminomatous Germ Cell Tumors First Results Of The German Testicular Cancer Study Group. The Journal of Urology 183(4): e250-e251, 2010

Histopathological and biological prognostic risk factors in low stage testicular nonseminomatous germ cell tumors. Urologe Ausgabe A 38(2): 168-178, 1999