Affiliation:
1. Division of Endocrinology and Andrology, Department of Experimental Medicine Sapienza University Rome Italy
2. Division of Oncology B, Department of Radiological, Oncological and Anatomopathological Sciences Sapienza University Rome Italy
3. Division of Oncology A, Department of Medical‐Surgical Sciences and Biotechnologies Sapienza University Latina Italy
4. Department of Radiological, Oncological and Pathological Sciences Sapienza University Rome Italy
5. Department of Maternal and Child Health and Urological Sciences Sapienza University Rome Italy
Abstract
AbstractBackgroundBilateral testicular germ cell tumours (B‐GCT) are rare, with an incidence of 2–5%, and can be classified as synchronous (sB‐GCT) or metachronous (mB‐GCT). Our study aimed to identify clinical, biochemical, and radiological risk factors for mB‐GCT in a cohort of patients with GCT at a single tertiary referral centre.MethodsThis retrospective case‐control study included patients with GCT referred to Policlinico Umberto I—Sapienza University of Rome, from 2005 to 2023. We evaluated clinical history, testicular ultrasound features, hormone levels, semen analysis, histological characteristics, staging, and treatments. mB‐GCTs were compared with unilateral GCT patients with a follow‐up longer than the median time‐to‐onset of the second tumour.ResultsOf 319 patients, 52 experienced B‐GCT, with a median time‐to‐onset of the second tumour of 62 months (range: 8–229). The mB‐GCT group showed higher gonadotropin levels (FSH 13.6mUI/mL vs. 7.4mUI/mL, p < 0.001; LH 6.6mUI/mL vs. 3.9mUI/mL, p = 0.004), lower sperm concentration (27 × 106/ejaculate vs. 78 × 106/ejaculate, p = 0.009), smaller residual testis volume (10.4 mL vs. 16.3 mL, p < 0.001), more inhomogeneous echotexture [57.5% vs. 14%, p < 0.001], and presence of microlithiasis (75% vs. 19.5%, p < 0.001). Kaplan–Meier curves confirmed that ultrasound features of the residual testis increased the cumulative risk of developing a second tumour. Microlithiasis was a strong independent predictor (OR 30.712, 95% CI 3.357–280.942, p = 0.002).ConclusionsHistological features of the first tumour or its treatment do not influence the onset of a second tumour. However, low residual testis volume, inhomogeneous echotexture, and microlithiasis significantly increase this risk. A comprehensive evaluation of the residual testis at baseline is essential for developing a personalised surveillance programme in GCT survivors, with regular ultrasound follow‐up recommended beyond the conventional 5‐year limit.