In the management of a Stage I (T1–T2 N0M0) non-seminomatous germ cell tumour (NSGCT) of the testis after radical orchidectomy, which parameter on histology defines a 'high-risk' Stage I NSGCT that may benefit from one cycle of adjuvant BEP chemotherapy?
- A Tumour size >4 cm and absence of rete testis invasion
- B Lymphovascular invasion (LVI) and/or the predominance of embryonal carcinoma component >50% ✓
- C Elevated serum AFP (>1000 ng/mL) at presentation before orchidectomy
- D Presence of teratoma component in the tumour
Explanation
For Stage I NSGCT, the risk of occult metastatic disease and relapse stratification is based on histological risk factors: lymphovascular invasion (LVI) is the single most important predictor, conferring approximately 50% relapse risk vs. 15–20% without LVI. A high proportion of embryonal carcinoma (>50%) is an additional risk factor in some guidelines. High-risk Stage I NSGCT patients are offered adjuvant 1 cycle of BEP (bleomycin, etoposide, cisplatin) or close surveillance; the European consensus includes both LVI and embryonal carcinoma predominance as risk factors. Tumour size >4 cm applies to risk stratification in seminoma (Stage I), not NSGCT.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.