The following is a summary of “Long-term Outcomes of Regressed or “Burnt Out” Primary Testicular Germ Cell Tumors,” published in the August 2024 issue of Urology by Baky et al.

This study aims to evaluate the clinical presentation and long-term oncologic outcomes of patients diagnosed with regressed or “burnt-out” primary testicular germ cell tumors (GCTs). These particular GCTs are characterized by the complete regression of the primary tumor, which raises concerns about whether this phenomenon is associated with more aggressive disease or poorer long-term outcomes. To address this, researchers conducted a retrospective analysis of a prospectively maintained testicular cancer clinical database from a leading tertiary cancer center, identifying patients who had undergone radical orchiectomy for regressed primary GCTs between 1990 and 2023. Importantly, none of these patients had received prior chemotherapy. The pathological specimens were meticulously reviewed by a genitourinary pathologist at the time of diagnosis, and the long-term clinical outcomes were evaluated using the Kaplan-Meier method.

A total of 56 patients met the inclusion criteria for this analysis. At the time of diagnosis, 17 patients had no evidence of extra-testicular disease, while 39 patients presented with advanced disease (clinical stage [CS] II+). Patients with no viable disease or germ cell neoplasia in situ at orchiectomy and those without evidence of advanced disease (CSx and CS0) were managed with surveillance. These patients demonstrated a 5-year recurrence-free survival (RFS) rate of 88% (95% CI: 39%, 98%). Conversely, all patients with CS II+ disease underwent primary treatment, either through surgery (n=5) or first-line chemotherapy (n=34). The two-year and five-year RFS rates for patients with CS II+ disease were 94% (95% CI: 78%, 98%) and 90% (95% CI: 72%, 97%), respectively.

In conclusion, patients with regressed primary testicular GCTs frequently present with advanced disease, likely due to the absence of early clinical signs from the primary tumor. Despite this, the analysis indicates that these patients have excellent long-term oncologic outcomes comparable to those reported for patients with viable primary testicular GCTs. These findings reassure that regressed primary GCTs, although potentially presenting at a more advanced stage, do not inherently predict poorer long-term survival.

Source: sciencedirect.com/science/article/abs/pii/S009042952400640X