Seminoma accounts for 30-50% of testicular germ cell tumors (TGCT)-the most common solid malignancy in men aged 15-35 years. The American Joint Committee on Cancer (AJCC) 8th edition (2018) created the subclassifications pT1a (tumor size < 3 cm) and pT1b (≥ 3 cm), despite not being universally recognized. Rete testis invasion (RTI) and tumor size > 4 cm are considered features associated with a higher recurrence risk, but not formally used for staging. The authors propose further understanding the subclassification's potential impact in clinical practice, by summarizing current evidence and reviewing clinical cases in their institutions.
All consecutive cases of seminoma stage I, pT1 treated in two institutions between January 2005 and December 2016 were included. Clinical data were retrieved, and variables were analyzed using SPSS. Relevant literature on the topic was reviewed.
Seminoma pT1 was identified in 58 patients. By using newly AJCC criteria, 29 (50%) would have been staged as pT1a and 29 (50%) pT1b. Median age at diagnosis was similar (33 in pT1a vs 32 in pT1b). Median follow-up time 5.8 years. Almost half (45%) of pT1b patients had a tumor size < 4 cm. The majority of either pT1a or pT1b were treated with chemotherapy or radiotherapy, reflecting more intensive approaches in the past. Three retroperitoneal recurrences were recorded (two in pT1a, one in pT1b, all under surveillance protocol); no deaths occurred. RTI and extensive necrosis (EN) were associated with pT1b (P < 0.0001 and P = 0.023, respectively), known adverse biological features.
In our population, the exploratory analysis of the newly created AJCC criteria showed no significant difference in recurrence or death, although pT1b was associated with adverse biomarkers, such as RTI and EN, but its clinical relevance remains incompletely understood. Our results confirm an excellent prognosis, regardless of subcategorization, thus a larger population and a longer follow-up time are needed to understand prospectively the impact of the recently updated criteria. We would recommend using the latest AJCC staging system, although the individual risk of relapse, long-term toxicities and patient preferences should be taken into account when considering surveillance or active treatment adjuvant options.
BMC urology. 2020 Aug 20*** epublish ***
Mário Fontes-Sousa, João Lobo, Helena Magalhães, João Cassis, Mariana Malheiro, Sância Ramos, Rui Henrique, Ana Martins, Maria Joaquina Maurício
Serviço de Oncologia Médica, Centro Hospitalar Lisboa Ocidental, Estr. Forte do Alto Duque, 1449-005, Lisbon, Portugal. ., Serviço de Anatomia Patológica, Instituto Português de Oncologia do Porto, Porto and Grupo de Epigenética e Biologia do Cancro (GEBC), Centro de Investigação do Instituto Português de Oncologia do Porto (CI-IPOP) e Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto (ICBAS-UP), Porto, Portugal., Serviço de Oncologia Médica, Unidade Local de Saúde de Matosinhos (Hospital Pedro Hispano), Porto, Portugal., Serviço de Anatomia Patológica, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal., Serviço de Oncologia Médica, Centro Hospitalar Lisboa Ocidental, Estr. Forte do Alto Duque, 1449-005, Lisbon, Portugal., Serviço de Oncologia Médica, Instituto Português de Oncologia do Porto, Porto, Portugal.