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Type: Journal article
Title: A refined risk stratification scheme for clinical stage 1 NSGCT based on evaluation of both embryonal predominance and lymphovascular invasion
Author: Lago-Hernandez, C.
Feldman, H.
O'Donnell, E.
Mahal, B.
Perez, V.
Howard, S.
Rosenthal, M.
Cheng, S.
Nguyen, P.
Beard, C.
D'Amico, A.
Sweeney, C.
Citation: Annals of Oncology, 2015; 26(7):1396-1401
Publisher: Oxford University Press
Issue Date: 2015
ISSN: 0923-7534
Statement of
C. A. Lago-Hernandez, H. Feldman, E. O, Donnell, B. A. Mahal, V. Perez, S. Howard, M. Rosenthal, S. C. Cheng, P. L. Nguyen, C. Beard, A. V. D, Amico, C. J. Sweeney
Abstract: Background: Active surveillance is an increasingly accepted approach for managing patients with germ-cell tumors (GCTs) after an orchiectomy. Here we investigate a time-to-relapse stratification scheme for clinical stage 1 (CS1) nonseminoma GCT (NSGCT) patients according to factors associated with relapse and identify a group of patients with a lower frequency and longer time-to-relapse who may require an alternative surveillance strategy. Patients and methods: We analyzed 266 CS1 GCT patients from the IRB-approved DFCI GCT database that exclusively underwent surveillance following orchiectomy from 1997 to 2013. We stratified NSGCT patients according to predominance of embryonal carcinoma (EmbP) and lymphovascular invasion (LVI), using a 0, 1, and 2 scoring system. Cox regression and conditional risk analysis were used to compare each NSGCT group to patients in the seminomatous germ-cell tumor (SGCT) category. Median time-to-relapse values were then calculated among those patients who underwent relapse. Relapse-free survival curves were generated using the Kaplan–Meier method. Results: Fifty (37%) NSGCT and 20 (15%) SGCT patients relapsed. The median time-to-relapse was 11.5 versus 6.3 months for the SGCT and NSGCT groups, respectively. For NSGCT patients, relapse rates were higher and median timeto- relapse faster with increasing number of risk factors (RFs). Relapse rates (%) and median time-to-relapse (months) were 25%/8.5 months, 41%/6.8 months and 78%/3.8 months for RF0, RF1 and RF2, respectively. We found a statistically significant difference between SGCT and patients with one or two RFs (P < 0.001) but not between SGCT and NSGCT RF0 (P = 0.108). Conclusion: NSGCT patients grouped by a risk score system based on EmbP and LVI yielded three groups with distinct relapse patterns -and patients with neither EmbP nor LVI appear to behave similar to SGCT.
Keywords: nonseminoma germ-cell tumor; clinical stage 1; relapse; embryonal predominance; lymphovascular invasion; active surveillance
Rights: © The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact
DOI: 10.1093/annonc/mdv180
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