Prevalence of intratubular germ cell neoplasia and multifocality in testicular germ cell tumors ≤ 2 cm: relationship with other pathological features

Abstract

Introduction: The aim of this study was to determine the prevalence of TIN and multifocality in men undergoing radical orchiectomy for testicular germ cell tumor (TGCT), and among those with a main tumor size ≤ 2 cm, potentially eligible for testis-sparing surgery. Patients and Methods: Orchiectomy specimens from 126 consecutive patients treated for TGCT tumor between 2003 and 2012 were included. Multifocality was defined as a distinct tumor focus with a diameter ≥ 1 mm separable from the main tumor mass. Uni- and multivariate logistic regression was performed to identify the association between pathological variables and multifocality and to identify variables for predicting clinical stage II to III and pathological stage ≥ pT2. Results: Of the 126 patients, 103 (82.0%) had clinical stage I cancer at presentation and 23 (18.0%) had clinical stage II to III. The median size of the primary tumor mass was 3.7 cm (range, 0.5-12 cm) in multifocality and 3.0 cm (range, 0.6-8.0 cm) in monofocality, respectively (P < .05). The prevalence of multifocality and TIN was lower in the presence of a smaller main tumor mass (≤ 1 cm) compared with tumors 1.1 to 2.0 cm (P < .05), and increased when the index mass tumor diameter was ≥ 2 cm (P trend < .05). No association was found between tumor histology and multifocality (P = .95) or TIN (P = .54) using the χ2 test. Conclusion: The prevalence of multifocality and TIN was decreased in smaller tumors (≤ 1 cm) and increased when the index mass tumor diameter was ≥ 1.1 cm