Subcentimeter Pulmonary Nodules in Patients With Clinical Stage I Non-Seminoma: Impact on Risk and Patterns of...

Indeterminate subcentimeter pulmonary nodules identified during the initial staging of patients with clinical stage I non-seminoma germ cell tumor (NSGCT) remain of uncertain clinical significance and yet can increase patient anxiety and cloud management decisions. We seek to evaluate the incidence and risk of disease recurrence in stage I NSGCT patients with subcentimeter pulmonary nodules.

Patients with clinical stage I NSGCT receiving an orchiectomy from 2003 to 2024 with at least 3-months of follow-up were identified (n = 215). Patient demographics, pathologic characteristics, administration of adjuvant therapy, and disease relapse data were collected. Initial staging imaging reports were reviewed identifying patients with SPN (< 1cm). The relationship between SPN and disease recurrence was investigated.

We identified 215 patients with stage I NSGCT, of whom 71 (33.0%) had SPN on initial staging imaging. A total of 52 patients (24.2%) received adjuvant treatment (primary RPLND 31 patients, primary chemotherapy 21 patients), with no significant difference in therapy between patients with and without SPN (P = .09). At a median follow-up of 22-months, disease recurrence occurred in 51 (23.7%) patients. The presence of SPN was not associated with increased risk of disease recurrence on univariate analysis (P = .12) and was associated with a decreased risk of recurrence on multivariable analysis (OR (95% CI): 0.38 (0.17, 0.83); P = .02). Of 6 patients who progressed to metastatic lung disease, only 1 patient had SPN at the time of presentation.

Our study suggests that SPN in stage I NSGCT are not associated with an increased risk of disease relapse. These findings may be used in patient counseling and to avoid overtreatment in management decisions.