Patient-Reported Outcomes and Long-Term Toxicity in stage I TGCT: A Retrospective Single-Center Cohort (1994-2023)

In clinical stage I (CSI) testicular germ-cell tumors (TGCT), cancer-specific survival after orchiectomy is near-universal. As oncologic outcomes converge, patient-centered outcomes-late comorbidities and health-related quality of life (HRQoL)-should help to inform the choice between surveillance and adjuvant therapy. We evaluated long-term comorbidities and HRQoL according to initial management in a risk-adapted cohort.

Single-center retrospective cohort (1994-2023). Consecutive CSI TGCT survivors completed the EORTC QLQ-C30, QLQ-TC26 and RAND SF-36. Of 159 eligible, 128 returned analyzable questionnaires. Late comorbidities were abstracted as binary endpoints and summarized as proportions with 95% confidence intervals (CIs); between-group contrasts were interpreted descriptively. PRO differences were evaluated using mean differences (95% CIs), effect sizes, and established thresholds for clinical relevance.

Frequent late complications included dyslipidemia (39.9%), hypertension (13.7%), diabetes (9.5%), chronic fatigue (16.7%), hypogonadism (17.5%), hearing loss (9.3%) and peripheral neuropathy (10.1%). Surveillance and adjuvant groups showed broadly similar comorbidity profiles. Exploratory analyses by treatment intensity showed no consistent dose-toxicity pattern, although point estimates numerically tended to be higher after 2 cycles (vs. 1) for several neurosensory and cardiometabolic endpoints. Global HRQoL was high across strategies, and between-group differences in EORTC and SF-36 scores generally did not reach conventional thresholds for clinical relevance. Sexual domains were generally favorable at the group level, although a clinically relevant subset reported sexual difficulties.

In this 3-decade cohort of long-term CSI TGCT survivors, we observed high overall HRQoL and no clear differences in late comorbidity prevalence by initial management strategy, although subgroup estimates were limited by small numbers. The findings support minimization of cumulative platinum exposure when adjuvant therapy is selected and highlight the importance of structured survivorship care addressing cardiometabolic risk, neurosensory and endocrine sequelae and psychological wellbeing, including routine attention to sexual health as part of comprehensive survivorship care.