Residual Nonretroperitoneal Disease After Chemotherapy for Nonseminomatous Germ Cell Tumors

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In a single-institution study reported in the Journal of Clinical Oncology, King et al identified the prevalence of teratoma and active germ cell tumor in patients with residual nonretroperitoneal disease following chemotherapy for advanced nonseminomatous germ cell tumors.

As stated by the investigators: “The majority of patients with advanced nonseminomatous germ cell tumor are cured with combination chemotherapy and surgical resection of residual disease when appropriate. In patients with both retroperitoneal and nonretroperitoneal postchemotherapy residual disease, management of the nonretroperitoneal disease is typically guided by pathologic findings at the time of retroperitoneal resection. There are limited data to help guide management decisions in patients with nonretroperitoneal postchemotherapy residual disease alone.”

Study Details

The study involved data from 129 patients from the Indiana University testicular cancer database with metastatic nonseminomatous germ cell tumors treated between 1990 and 2021 who had residual nonretroperitoneal disease in the absence of residual retroperitoneal disease after completing either first-line or salvage chemotherapy.

Key Findings

Among the 129 patients, 75 had teratoma in the primary tumor site. Among these patients, 41 (55%) had teratoma, 23 (31%) had nonteratoma active germ cell tumor, and 21 (28%) had necrosis in the resected nonretroperitoneal specimens.

Among the 54 patients without teratoma in the primary site, 9 (17%) had teratoma (P < .001 vs those with teratoma in primary site), 30 (56%) had nonteratoma active germ cell tumor (P = .0046 vs those with teratoma in primary site), and 20 (37%) had necrosis in the resected nonretroperitoneal specimens.

The investigators concluded: “The presence of teratoma in the primary tumor site is associated with a higher rate of teratoma in postchemotherapy residual nonretroperitoneal disease. Patients without teratoma in the primary tumor should still be considered for resection of residual postchemotherapy disease that could harbor teratoma or active germ cell tumor.”

Jennifer M. King, MD, of the Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by Indiana University internal funds. For full disclosures of the study authors, visit

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