α‐catenin expression pattern and DNA image‐analysis cytometry have no additional value over primary histology in clinical stage I nonseminomatous testicular cancer

• Published in: BJU international Vol. 89; no. 3; pp. 278 - 284
• Main Authors: Spermon, J.R., De Wilde, P.C., Hanselaar, A.G.J.M., Schaafsma, H.E., Ruijter, T.E.G., Witjes, J.A., Van Moorselaar, R.J.A.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01-02-2002; Blackwell
• Subjects: alpha Catenin; Biological and medical sciences; Cytoskeletal Proteins - metabolism; DNA, Neoplasm - metabolism; DNA‐content; Gynecology. Andrology. Obstetrics; Humans; Image Cytometry - methods; Immunohistochemistry; Lymphatic Metastasis; Male; Male genital diseases; Medical sciences; Neoplasm Invasiveness; Neoplasm Metastasis - pathology; Neoplasms, Germ Cell and Embryonal - pathology; Neoplasms, Germ Cell and Embryonal - secondary; Ploidies; Prognosis; Regression Analysis; Risk Factors; Sensitivity and Specificity; testicular cancer; Testicular Neoplasms - pathology; Tumors; vascular invasion; Human; Immunohistochemistry; Space occupying lesion; Stage classification; Male; Asymptomatic; Non seminomatous tumor; Metastasis; Malignant tumor; Gene expression; Testicle; Angiogenesis; DNA; Diagnosis; Male genital diseases; Catenin; Testicular diseases
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1046/j.1464-4096.2001.2417.x

Objective To determine whether the α‐catenin expression pattern and DNA content have additional value over primary tumour histology, including information on vascular invasion and tunica albuginea invasion, in detecting occult metastasis in patients with clinical stage I nonseminomatous germ cell tumours of the testis (NSGCT).
Patients and methods Fifty consecutive patients with clinical stage I NSGCT underwent retroperitoneal lymphadenectomy (RPLND) between 1986 and 1992. The orchidectomy specimens were histopathologically reviewed and immunohistochemically stained with mouse monoclonal anti‐α‐catenin antibody. The presence of an aberrant or negative staining in >10% of the malignant cells was defined as abnormal; in all other cases tumours were classified as normal. Furthermore, intact nuclei were isolated from 50 µm thick paraffin sections of the primary tumour, Feulgen stained, and analysed with an image‐analysis system.
Results Of the 50 patients, 14 had positive retroperitoneal nodes (stage IIa, 28%), one pathologically staged I patient developed a lung metastasis (stage IV) within 3 months of RPLND. Univariate analysis showed that the presence of embryonal cell carcinoma, vascular invasion and tunica albuginea invasion were predictive for occult metastases. In multivariate logistic regression analysis only vascular and tunica albuginea invasion were significant. All 11 patients with no embryonal cell carcinoma in the primary tumour were classified as having pathological stage I disease. Also, the tumours which were DNA‐diploid (three) or DNA‐polyploid (two) were pathologically stage I. In screening for occult metastases the DNA content and the α‐catenin expression pattern had no additional value.
Conclusion Vascular and tunica albuginea invasion have prognostic value in identifying patients with clinical stage I NSGCT at high risk for occult retroperitoneal disease. In contrast, the absence of embryonal cell carcinoma could predict all patients at low risk for metastasis. The DNA‐ploidy also identified patients at low risk. Other DNA‐analyses and the α‐catenin expression pattern provided no additional information. Further studies are recommended to identify patients who are at low or high risk for metastasis.