New prognostic factors identified for testicular seminoma relapse

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About 1 of every 5 patients with stage I seminoma relapses; however, “the level of evidence supporting the use of currently defined risk factors in decision making is low,” wrote lead author Thomas Wagner, MD, and coinvestigators.

Danish researchers have identified several new prognostic factors for relapse in patients with clinical stage I testicular seminoma, according to results published in the Journal of Clinical Oncology (JCO).1

“The identified prognostic factors enable providers and patients to make more informed decisions about post-orchiectomy management, and could be incorporated into clinical guidelines and be used in future studies investigating risk adapted follow-up and treatment strategies,” Michael A. Carducci, MD, associate editor, JCO, wrote in a commentary published alongside the manuscript.

“The identified prognostic factors enable providers and patients to make more informed decisions about post-orchiectomy management, and could be incorporated into clinical guidelines and be used in future studies investigating risk adapted follow-up and treatment strategies,” Michael A. Carducci, MD, associate editor, JCO, wrote in a commentary published alongside the manuscript.

Lead author Thomas Wagner, MD, department of Oncology, Copenhagen University Hospital, Denmark, identified 4 independent predictors of relapse in this patient population: invasion of the testicular hilum (rete testis and hilar soft tissue; P <.0001 for both), lymphovascular invasion (P <.0001), elevated pre-orchiectomy levels of β-human chorionic gonadotropin (b-hCG; P <.0001), and elevated pre-orchiectomy levels of lactate dehydrogenase (LDH; P <.0001).

Wagner et al’s nationwide, population-based cohort study included 924 patients diagnosed with clinical stage I seminoma from January 2013 to December 2018. Patients were identified from the Danish Testicular Cancer database. At a median follow-up of 6.3 years, 16% (n = 148) of patients relapsed.

Using statistical modeling, Wagner et all determined that the risk of relapse was only 6 % in patients with no risk factors, as compared to 62% in patients who had “all 4 risk factors with tumor extension into the hilar soft tissue of the testicular hilum.”

“The provided prognostic factors are easily incorporated into routine clinical practice, could replace current risk factors in guidelines, and could be used in future studies investigating risk-adapted follow-up and treatment strategies,” Wagner et al wrote in their study conclusion.

Explaining the background of the study, Wagner et al noted that about 1 of every 5 patients with stage I seminoma relapses; however, “the level of evidence supporting the use of currently defined risk factors in decision making is low [and therefore] we investigated prognostic factors for relapse in a truly unselected population-based cohort of patients with clinical stage I seminoma.”

The median age of the 924 patients was 40 years (range, 19-84) and the median tumor size at baseline was 35 mm. Overall, 29% of patients had elevated b-hCG at baseline, 38% of patients had elevated LDH. Additionally, 37% of patients had tumor necrosis, 13% of patients had lymphovascular invasion, 46% of patients had rete testis invasion, 19% had hilar soft tissue invasion, 3.5% had epididymis invasion, and 2% had spermatic cord invasion.

“The identified prognostic factors enable providers and patients to make more informed decisions about post-orchiectomy management, and could be incorporated into clinical guidelines and be used in future studies investigating risk adapted follow-up and treatment strategies,” Michael A. Carducci, MD, associate editor, JCO, wrote in a commentary published alongside the manuscript.

Reference

1. Wagner T, Toft BG, Lauritsen J, et al. Prognostic Factors for Relapse in Patients With Clinical Stage I Testicular Seminoma: A Nationwide, Population-Based Cohort Study [published online ahead of print September 8, 2023]. J Clin Oncol. doi: 10.1200/JCO.23.00959

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