Post-orchiectomy systemic inflammatory indexes are associated with tumor characteristics in clinical stage I germ cell tumours

Peter Lesko Michal Mego ^*

• National Institute for Oncology (Slovakia), Bratislava, Slovakia

Background: Approximately 25-30% of clinical stage I (CSI) GCT patients will experience disease relapse after orchiectomy. Adding adjuvant treatment will decrease relapse rate, however, on the contrary leads to over-treatment. Prognostic biomarkers such as lymphvascular invasion (LVI) and/or embryonal carcinoma (EC) in non-seminoma (NSGCT) and rete testis invasion (RTI) and/or primary tumor size (PTS) in seminoma (SGCT) add limited value in treatment decision making. The aim of this study is to assess systemic inflammatory (SI) indexes and lactate-dehydrogenase (LDH) with clinico-pathological findings along with their prognostic impact.Methods: This is retrospective study, which included 159 diagnosed CSI GCT patients, who underwent active surveillance (AS) from June 2004 to November 2023. Medical records and pathology reports were collected retrospectively. Blood drawn must have been done less than 3 months since orchiectomy had been done. For survival analysis we used dichotomized values of studied biomarkers to "low" and "high" based on median value.Results: Median follow-up was 61 months (ranging from 1-230 months), with 2-years relapse free survival (RFS) 81.3% and 69.0% in SGCT and NSGCT respectively. We confirm inferior RFS among LVI presence compared to LVI absence in NSGCT ([HR]= 2.59, 95%CI (0.74-9.07), p=0.04). Trend to inferior RFS in NSGCT patients with EC predominance (≥50%) was observed as well ([HR]= 2.59, 95%CI (0.98-6.85), p=0.06). Prognostic impact of RTI and PTS(>4cm) in SGCT was not observed, p=0.24 and p=0.51, respectively. SI indexes were assessed among population, where higher neutrophil to lymphocyte ratio (NLR) value was associated with LVI presence and with advanced tumor stage in NSGCT. In SGCT, higher systemic inflammatory index (SII) level was associated with LVI presence as well as with advanced pathological stage. PTS (>4cm) was associated with higher LDH level among cohort of all studied patients, without significance among SGCT nor among NSGCT. Higher LDH value in NSGCT was also associated with EC predominance (≥50%).Our study for the first-time revealed associations of post-orchiectomy systemic inflammatory indexes and/or LDH in CSI GCT. Those new associations deserve further evaluation on larger cohort of CSI GCT to elucidate, whether, its associations in certain histology subgroups will improve stratification of risky population.