Intratumoral Heterogeneity, Chemoresistance and Lymph Node Landing Zone Prognosis in Testicular Tumors Based on Histopathological Characteristics

Ann Surg Oncol. 2024 May;31(5):3544-3553. doi: 10.1245/s10434-024-15051-z. Epub 2024 Feb 21.

Abstract

Background: Existing data on the histopathological correlation of testicular tumors with lymph node prognosis have been poorly explored. We aimed to investigate the relationship of the histopathological properties of testicular tumors with lymph nodes and their involvement with chemoresistance and heterogeneity of testicular tumors.

Methods: Patients with non-seminomatous germ cell tumor (NSGCT) were selected for histopathological correlation of testicular tumor with lymph nodes and its relationship with chemoresistance and heterogeneity. Histopathological and radiological parameters associated with the risk of chemoresistance and tumor progression were measured pre- and post-chemotherapy. Binomial logistic regression and Kaplan-Meier analysis were implemented to determine the predictors of progression and adverse overall patient survival. All categorical variables were analyzed using the Chi-square test, while Pearson's R coefficient determined the correlation.

Results: Male patients who were diagnosed with NSGCT from March 2017 to December 2018 at Guwahati Medical College, Guwahati, India, were included in this study. Lymph node groups were predominantly incriminated with the EYST or EYS groups and minimally linked with the pure E and YCS groups. Furthermore, the highest number of lymph node stations was associated with pre-chemotherapy. In salvage chemotherapy in the form of VIP, we found exciting outcomes, as approximately 41% of cases responded positively, especially in the EYS group.

Conclusion: Our study classifies NSGCT according to the most favorable histopathological grouping and explores the tumoral response in different intrinsic and extrinsic variables. Our analysis can serve as a triumphant histopathological nomogram for a sublime management protocol to deal with the onerous histological pairing in NSGCT.

Keywords: Chemoresistance; Intratumoral heterogeneity; Lymph node progression; Non-seminomatous germ cell tumor; Survival.

MeSH terms

  • Drug Resistance, Neoplasm
  • Eye Proteins / therapeutic use
  • Humans
  • Lymph Node Excision
  • Lymph Nodes / pathology
  • Male
  • Neoplasms, Germ Cell and Embryonal* / drug therapy
  • Neoplasms, Germ Cell and Embryonal* / pathology
  • Prognosis
  • Retroperitoneal Space / pathology
  • Retrospective Studies
  • Testicular Neoplasms* / drug therapy

Substances

  • EYS protein, human
  • Eye Proteins