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Organo Oficial de la Sociedad Mexicana de Urología

2009, Number 5

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Rev Mex Urol 2009; 69 (5)

Stage I nonseminomatous germ cell tumor management: a comparative analysis

Hernández-Castellanos V, Camarena-Reynoso HR, Vázquez-Ortega L, Mata MP, Leos-Acosta C, Morales-Montor JG, Pacheco-Gahbler C, Calderón-Ferro F

Language: Spanish
References: 27
Page: 200-205
PDF size: 2385.14 Kb.


ABSTRACT

Objective: To evaluate stage I nonseminomatous tumor progression in patients in relation to treatment.
Materials and methods: An analytical cross-sectional study was carried out. Case records of patients diagnosed with testicular neoplasia who were treated in the authors’ institution between January 1989 and October 2008 were reviewed. Multiple variables were analyzed using descriptive statistics and measures of central tendency and dispersion. Disease-free period was analyzed using Kaplan-Meier curves and logrank test. Multivariate Cox analysis and chisquare test were used for categorical recurrence analysis.
Results: A total of 189 patients with germ cell tumors were identified, 104 of whom (55%) presented with nonseminomatous tumors. Fifty of those patients (48%) were in stage I, 19 (38%) in stage IA, 15 (30%) in stage IB and 16 (32%) in stage in situ. Disease-free period tended to be lower in stage IB patients (45% of patients at 5 years; P= 0.10). In relation to risk factors, there was recurrence in patients with a tumor volume percentage of embryonal cell carcinoma ›50% (P = 0.001) and 13% of patients were disease-free at 5 years (P = 0.0001). There was recurrence in 84% of patients with lymphovascular invasion (P = 0.005) and 51% of patients were disease-free at 5 years (P = 0.01). Twenty-eight percent of patients with immature teratoma were diseasefree at 5 years (P = 0.04). Regarding treatment, there was recurrence in 29.01% of patients treated with surveillance vs. 12.5% of patients receiving chemotherapy (P = 0.17). Disease-free period was not statistically significant (65% for patients treated with surveillance vs 90% for patients receiving chemotherapy at 5 years; P = 0.29).
Conclusions: Recurrence in patients treated with surveillance was not statistically significant (P = 0.17) with a disease-free period at 5 years in only 65% of patients. The risk factors of embryonal cell carcinoma ›50% and lymphovascular invasion were statistically significant for predicting recurrence, whether together or as independent factors.


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