PERCENTAGE OF EMBRYONAL CARCINOMA AND OF VASCULAR INVASION PREDICTS PATHOLOGICAL STAGE IN CLINICAL STAGE-I NONSEMINOMATOUS TESTICULAR CANCER

We analyzed 92 clinical stage I nonseminomatous testicular germ cell t umors for primary tumor histological factors that would distinguish tr ue pathological stage I disease (N = 54) from those patients who harbo red occult disease and actually were later found to have pathological stage II disease (N = 38). Primary tumor pathological material was ana lyzed for vascular invasion, lymphatic invasion, tunical invasion, and quantitative determination of percentage of the primary tumor compose d of embryonal carcinoma, yolk sac carcinoma, teratoma, and seminoma. Univariate logistic regression analyses revealed that vascular invasio n (P = 0.0001), percentage of embryonal carcinoma (P = 0.0001), lympha tic invasion (P = 0.0001), and tunical invasion (P = 0.0013) were high er in pathological stage II and that percentage of teratoma (P = 0.000 1) and of yolk sac carcinoma (P = 0.0174) were higher in stage I. Perc entage of seminoma was not significant. Individually, these parameters were able to correctly predict occult disease 66.3 to 80.4% of the ti me. In multivariate logistic regression analysis, only vascular invasi on and percentage of embryonal carcinoma remained significant, and a m odel using these two variables was able to correctly predict stage 85. 9% of the time. Vascular invasion and determination of percentage of e mbryonal carcinoma should be assessed for all clinical stage I nonsemi nomatous germ cell tumor patients and the model presented herein can b e used clinically to predict the likelihood of occult disease and dict ate therapy.