IMPLICATIONS OF BIOLOGICAL PROGNOSTIC FAC TORS FOR THE TREATMENT OF NONSEMINOMATOUS TESTICULAR-TUMORS IN CLINICAL STAGE-I - THE PRESENT STATUS

At present patients in whom a testicular germ cell tumour in clinical stage I is diagnosed have a longterm survival rate of 98%. For nonsemi nomatous germ cell tumours in this stage three different treatment opt ions are available: primary retroperitoneal lymphadenectomy (PRLA), th e wait-and-see strategy, and primary adjuvant systemic chemotherapy. T hese therapeutic approaches do not obviously differ in the long-term s urvival rate of the patients. Abdominal CT scans yield false-negative results in 20-30% of patients with occult metastases. The identificati on of certain histological characteristics within the primary tumour ( vascular and/or lymphatic invasion, presence of embryonal carcinoma, a bsence of yolk sac elements) allows stratification of patients into gr oups at high and low risk for tumour progression and/or the presence o f retroperitoneal lymph node metastases. The determination of biologic al and genetic characteristics of the primary tumour in addition to cl assic histological parameters, does not actually seem to reveal any fu rther prognostic information relating to the biological behaviour of t he individual tumour. Therefore, with regard to the outcome of prospec tive and retrospective MRC studies, patients should be stratified acco rding to the Freedman score into groups at high and at low risk of tum our progression and consequently undergo an aggressive (retroperitonea l lymphadenectomy/systemic chemotherapy) or less aggressive (wait-and- see) treatment adjusted to the aggressiveness of the individual tumour . Prospective studies should be performed to find whether biological c haracteristics of the primary tumour might reveal any additional progn ostic information superior to that yielded by histological parameters and possibly allow an even more subtle classification of the patients into high- and low-risk groups.