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Relapse in children with clinical stage I testicular yolk sac tumors after initial orchiectomy

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Abstract

Purpose

To evaluate risk factors of relapse in pediatric patients with clinical stage I (CS1) testicular yolk sac tumors.

Methods

With retrospective analysis, the medical records of children with pure testicular yolk sac tumors who were referred to Sun Yat-sen University Cancer Center and The First Affiliated Hospital from January 1995 to December 2015 were selected and recorded. Histopathology and staging were retrieved and multivariate analysis was performed with SPSS 20.0 software.

Results

90 children with CS1 testicular yolk sac tumors were selected, and 21 of them underwent chemotherapy following initial orchiectomy. The median age of them was 17 months. With a median follow-up of 61 months (range 11–183 months), 84 patients were alive and 3 patients died, whereas the status was unknown in 3 patients. 30 patients experienced relapse within a median time of 4 months, including only 1 patient who underwent primary chemotherapy, and 28 of these patients underwent salvage chemotherapy. According to adjusted analysis, lymphovascular invasion (LVI) (P < 0.001), necrosis (P = 0.003) and primary chemotherapy (P = 0.008) were independent predictors of event-free survival. The 4-year event-free survival of high- and low-risk patients was 46.5% and 85.1%, respectively (P < 0.001).

Conclusions

LVI and necrosis were independent risk factors for relapse in pediatric patients with CS1 testicular yolk sac tumors, and primary chemotherapy was effective. Thus, individualized management might be feasible for these patients according to risk classification.

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Data Availability

The authenticity of this article has been validated by uploading the key raw data onto the Research Data Deposit public platform (http://www.researchdata.org.cn), with the approval RDD number as RDDA2017000163.

Abbreviations

CS1:

Clinical stage I

LVI:

Lymphovascular invasion

RPLND:

Retroperitoneal lymph node dissection

YST:

Yolk sac tumor

RIO:

Radical inguinal orchiectomy

GCT:

Germ cell tumor

NSGCT:

Nonseminomatous germ cell tumor

PEB:

Cisplatin, etoposide and bleomycin

EP:

Etoposide and cisplatin

PVB:

Cisplatin, vinblastine and bleomycin

VIP:

Etoposide, ifosfamide and cisplatin

OS:

Overall survival

EFS:

Event-free survival

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Author notes

  1. Yun-lin Ye, Fu-fu Zheng and Dong Chen contributed equally.

Authors and Affiliations

  1. State Key Laboratory of Oncology in South China, Department of Urology, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, China

    Yun-lin Ye, Dong Chen, Ji Zhang, Zhuo-wei Liu, Zi-ke Qin & Fang-jian Zhou

  2. Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China

    Fu-fu Zheng

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  1. Yun-lin Ye
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Correspondence to Zi-ke Qin.

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No conflict of interest was declared.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Ye, Yl., Zheng, Ff., Chen, D. et al. Relapse in children with clinical stage I testicular yolk sac tumors after initial orchiectomy. Pediatr Surg Int 35, 383–389 (2019). https://doi.org/10.1007/s00383-018-04426-5

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