Identification of clinical stage A nonseminomatous testis cancer patients at extremely low risk for metastatic disease: A combined approach using quantitive immunohistochemical, histopathologic, and radiologic assessment

Purpose: To evaluate previously determined predictors of metastasis in low-stage testis cancer in a consecutive group of clinical stage A patients. Patients and Methods: Ninety-one consecutive clinical stage A nonseminomatous germ cell tumor (NSGCT) patients who underwent primary nerve-sparing retroperitoneal lymph node dissection (NSRPLND) had orchiectomy specimens and computed tomographic (CT) scans evaluated blindly in a quantitative fashion. These scores were then correlated with pathologic stage using previously determined paradigms. Results: Using volume of embryonal carcinoma in the orchiectomy specimen, lymph node diameters in the primary landing zones and MIB-1 staining of the orchiectomy specimen, 41 patients were classified as low risk for metastasis. Forty of these 41 had pathologic stage A disease at RPLND. Conclusion: These parameters can identify a low-risk group patients for metastasis who can be rationally offered surveillance.