Background

To assess if clinical, pathological, and spermatogenesis factors are associated with clinical staging in patients with testicular germ cell tumors.

Patients and methods

We retrospectively reviewed the pathology reports and slides from 267 men who underwent radical orchiectomy for testicular cancer at our institution during 1998-2019. Histologic slides were reviewed and the presence of mature spermatozoa was documented. Clinical, laboratory and radiographic characteristics were recorded. Logistic regression analyses were used to identify factors associated with advanced disease stage at diagnosis.

Results

Of 267 male patients, 115 (43%) patients had testicular non-seminomatous germ cell tumors (NSGCT) and 152 (57%) seminomatous germ cell tumors (SGCT). Among NSGCT patients, those presenting with metastatic disease had a higher proportion of predominant (>50%) embryonal carcinoma (64% vs. 43%, respectively, P = 0.03), and lymphovascular invasion (45.8% vs. 26.6%, respectively, P = 0.03) than non-metastatic patients. Spermatogenesis was observed in 56/65 (86.2%) and 36/49 (73.5%) of non-metastatic and metastatic NSGCT patients, respectively (P = 0.09). On semen analysis, severe oligospermia (<5 million/ml) was more common in metastatic than in non-metastatic NSGCT (26.5% vs. 8.3%, respectively, P = 0.04). On multivariate analysis, predominant embryonal carcinoma and lack of spermatogenesis in pathological specimens were associated with metastatic disease.

Conclusion

The absence of spermatogenesis and a high proportion of embryonal carcinoma was associated with advanced disease in patients with NSGCT. Whether it may also translate as a predictor of oncologic outcome needs further evaluation.

中文翻译：

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根治性睾丸切除术标本中缺乏精子发生与晚期非精原细胞性睾丸癌有关

背景

评估临床、病理和精子发生因素是否与睾丸生殖细胞肿瘤患者的临床分期相关。

患者和方法

我们回顾性回顾了 1998-2019 年间在我们机构接受睾丸癌根治性睾丸切除术的 267 名男性的病理报告和幻灯片。回顾组织学载玻片并记录成熟精子的存在。记录临床、实验室和放射学特征。逻辑回归分析用于确定与诊断时疾病晚期阶段相关的因素。

结果

在 267 名男性患者中，115 名（43%）患者患有睾丸非精原细胞生殖细胞肿瘤（NSGCT）和 152 名（57%）患者患有精原细胞生殖细胞肿瘤（SGCT）。在 NSGCT 患者中，转移性疾病患者的主要（>50%）胚胎癌（分别为 64% 和 43%，P  = 0.03）和淋巴血管侵犯（分别为 45.8% 和 26.6%，P  = 0.03）比非转移性患者。非转移性和转移性 NSGCT 患者的精子发生率分别为 56/65（86.2%）和 36/49（73.5%）（P  =0.09）。在精液分析中，严重少精子症（<500 万/ml）在转移性 NSGCT 中比在非转移性 NSGCT 中更常见（分别为 26.5% 和 8.3%，P = 0.04)。在多变量分析中，病理标本中主要的胚胎癌和精子发生缺乏与转移性疾病有关。

结论

NSGCT 患者缺乏精子发生和高比例的胚胎癌与晚期疾病有关。它是否也可以转化为肿瘤学结果的预测因子需要进一步评估。