Ezgi TÜRKOĞLU, Goncagül AKDAĞ, Sedat YILDIRIM, Nisanur SARIYAR BUSERY, Utku DÖNEM GÜNDOĞDU, Deniz IŞIK, Hatice ODABAŞ, Nedim TURAN
İstanbul Medical Journal - 2026;27(1):82-87
Introduction: Stage IS non-seminomatous germ cell tumors (NSGCT) represent a rare and clinically heterogeneous subgroup characterised by persistent postoperative elevation of serum tumor markers despite the absence of radiological metastasis. Evidence guiding optimal management remains limited because most studies address this population only as part of broader stage I cohorts. To evaluate the clinical characteristics, treatment strategies, tumor marker dynamics, and long-term oncological outcomes of patients with stage IS NSGCT managed at a single tertiary centre. Methods: This retrospective observational study included 25 patients diagnosed with stage IS NSGCT between 2008 and 2022. All patients demonstrated persistently elevated serum alpha-fetoprotein, beta-human chorionic gonadotropin, or lactate dehydrogenase following orchiectomy, with no radiological evidence of metastasis. Demographic, pathological, and treatment data were analysed. Disease-free survival (DFS) and overall survival (OS) were calculated using the Kaplan-Meier approach, and potential predictors of DFS were assessed through a univariate Cox regression model. Results: The median patient age was 26 years; mixed germ cell tumor histology accounted for 80% of cases. After orchiectomy, all patients received bleomycin, etoposide, and cisplatin chemotherapy; receiving >=3 cycles significantly reduced the risk of recurrence [hazard ratios (HR): 0.075, p=0.026)]. Rete testis invasion was associated with a trend toward an increased risk of relapse, although this did not reach statistical significance (HR: 8.389, p=0.066). At a median follow-up of 155.5 months, the 10-year relapse incidence was 16%, and median DFS and OS were not reached. Conclusion: Stage IS NSGCT carries a substantial risk of occult metastatic disease despite negative imaging, supporting the need for systemic therapy in most cases. Adequate chemotherapy intensity appears crucial for long-term disease control. Although certain pathological features-such as rete testis invasion-may indicate more aggressive biology, their prognostic relevance requires confirmation in larger, prospective cohorts.
