Prognostic factors in nonseminomatous testicular cancer

The clinical, pathological and laboratory data for 60 patients with pathological stage I, 50 with stage II and 55 with stage III nonseminomatous testicular cancer were reviewed to identify prognostic factors that may be used to guide therapeutic approaches. In patients with stage I disease the presence of embryonal carcinoma (p less than 0.001) and vascular invasion in primary tumors (p less than 0.01) are significant predictors of metastases and/or recurrence after retroperitoneal lymphadenectomy. In patients with clinical stage II disease, lymph nodes greater than 2 cm. in diameter or more than 5 in number, vascular and/or lymphatic invasion and the presence of embryonal carcinoma with or without choriocarcinoma indicated an increased risk for recurrent tumor after retroperitoneal lymphadenectomy. In patients with stage III disease the involvement of 3 or more organ systems was associated with decreased survival. Patients in this group with intrathoracic metastases smaller than 2 cm., retroperitoneal metastases less than 4 cm., normal kidneys and liver, and no evidence of yolk sac tumor or choriocarcinoma had improved survival. These observations can be used to guide the type and duration of therapy selectively in patients with nonseminomatous testicular cancer.