Where extranodal metastases occur in men with stage III testicular germ cell tumors (TGCTs) affects their risk of dying from the malignancy, a new study suggests.

Compared with patients whose primary site of distant metastasis was the lung only (reference), those with primary brain metastasis (with or without lung metastasis) had a significant 3.2-fold increased risk of dying from TGCT, Hiten D. Patel, MD, MPH, of Johns Hopkins University School of Medicine in Baltimore, and colleagues reported in Cancer. Patients with primary liver and bone metastases (with or without lung metastases) had an approximately 2-fold increased risk of TGCT-related death. Patients with multiple nonpulmonary sites of metastasis had a nearly 4.3-fold increased risk.

“These outcomes may reflect both the aggressive biology of these tumors and the challenging nature of treating these patients,” the authors concluded.

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Dr Patel and colleagues based their findings on an analysis of data from 969 men with stage III TGCTs in the Surveillance, Epidemiology, and End Results (SEER) registry from 2010 to 2015.  Of these, 535 (55.2%) were white, 338 (34.9%) were Hispanic, 39 (4.0%) were Asian, and 38 (3.9%) were black. The ethnicity of the remaining patients were Native American or Alaskan or not known. Patients had a median age of 29 years.

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Of the 969 men, 84% had nonseminomatous histology. Lung metastases were present in 91% of patients, whereas 20%, 10% and 10% had liver, bone, and brain metastases, respectively. Over a median follow-up period of 21 months, 19% of patients died from TGCTs.

In a discussion of study limitations, the investigators pointed out that, as a consequence of using the SEER registry, their investigation was retrospective and open to selection bias. In addition, the registry lacked data for certain variables of interest, such as the number and size of metastatic lesions and serum tumor markers, they noted.


Patel HD, Singla N, Ghandour RA, et al. Site of extranodal metastasis impacts survival in patients with testicular germ cell tumors. Cancer. 2019.  doi: 10.1002/cncr.32427