NEW PROGNOSTIC PARAMETERS FOR PREDICTION OF PATHOLOGICAL STAGE IN CLINICAL STAGE-I NSGCT OF THE TESTIS

Traditional histopathological risk factors have failed to predict path ological stage accurately in clinical stage I nonseminomatous testicul ar germ cell tumours. Histopathology, flow cytometry, cytophotometry, tochemical were used in an effort to define high- and low-risk groups for occult metastasis in a consecutive series of 105 patients who unde rwent retroperitoneal lymph node dissection. After multiple logistic r egression analysis, the proliferative S + G(2)M cell cycle fraction of the aneuploid tumour stemline was the most highly predictive paramete r of pathological stage (P = 0.0004). Using a cut-off of 41%, patholog ical stage II patients were predicted with a sensitivity of 71%. There were 61 patients with S + G(2)M values below 41%, and 43 of them had pathological stage I disease (negative predictive value 87%). A low vo lume of embryonal carcinoma was predominant in low-risk patients, and MIB-1 immunohistochemical staining identified a subgroup of 23% of pat ients with pathological stage I disease and at extremely low risk of m etastatic disease. Assessment of tumour cell proliferation does not al low accurate classification of high-risk patients at a level that is a dequate for clinical application. Patients who are at low risk of meta stasis, however, can be identified by flow cytometry, immunohistochemi cal proliferation markers and volume of embryonal carcinoma with 90% c ertainty. These parameters deserve further study, since identification of a subgroup of patients at extremely low risk of metastasis could p otentially reduce the overall morbidity in the management of clinical stage I nonseminomatous testis cancer.