Approximately 30% of patients with clinical stage I non-seminoma (CSI-NS) relapse. Current risk stratification is based on lymphovascular invasion (LVI) alone. The extent to which additional tumor characteristics can improve risk prediction remains unclear.
To determine the most important prognostic factors for relapse in CSI-NS patients.
Population-based cohort study including all patients with CSI-NS diagnosed in Denmark between 2013 and 2018 with follow-up until 2022. Patients were identified in the prospective Danish Testicular Cancer database. By linkage to the Danish National Pathology Registry, histological slides from the orchiectomy specimens were retrieved.
Histological slides were reviewed blinded to the clinical outcome. Clinical data were obtained from medical records. The association between prespecified potential prognostic factors and relapse was assessed using Cox regression analysis. Model performance was evaluated by discrimination (Harrell's C-index) and calibration.
Of 453 patients included, 139 patients (30.6%) relapsed during a median follow-up of 6.3 years. Tumor invasion into the hilar soft tissue of the testicular hilum, tumor size, LVI and embryonal carcinoma were independent predictors of relapse. The estimated 5-year risk of relapse ranged from < 5% to > 85%, depending on the number of risk factors. After internal model validation, the model had an overall concordance statistic of 0.75. Model calibration was excellent.
The identified prognostic factors provide a much more accurate risk stratification than current clinical practice, potentially aiding clinical decision-making.
European journal of cancer (Oxford, England : 1990). 2024 Mar 17 [Epub ahead of print]
Thomas Wagner, Birgitte Grønkær Toft, Jakob Lauritsen, Mikkel Bandak, Ib Jarle Christensen, Birte Engvad, Michael Kreiberg, Mads Agerbæk, Lars Dysager, Andreas Carus, Josephine Julie Rosenvilde, Daniel Berney, Gedske Daugaard
Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark. Electronic address: ., Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark., Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark., Department of Pathology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark., Department of Pathology, Odense University Hospital, J. B. Winsløws vej 15, Winsløwsparken 15, 5000 Odense C, Denmark., Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark., Department of Oncology, Odense University Hospital, J. B. Winsløws vej 15, Winsløwsparken 15, 5000 Odense C, Denmark., Department of Oncology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark., Centre of Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Charterhouse Square, Queen Mary University of London, London, UK.