PROGNOSIS OF TESTICULAR GERM CELL TUMORS: EXPERIENCE FROM THE MEDICAL ONCOLOGY DEPARTMENT OF HASSAN II HOSPITAL IN FEZ AND A REVIEW OF THE LITERATURE

Introduction: Testicular germ cell tumors (TGCTs) account for 98% of malignant testicular tumors and are the most common solid malignancies in men aged between 15 and 35 years. This study describes the prognosis and management of 48 patients treated for TGCTs at Hassan II University Hospital in Fez, Morocco, between January 2017 and September 2024.

Materialand Methods: A retrospective analysis was conducted using medical records of 48 patients with TGCTs. Data on demographics, clinical presentation, treatment modalities, and outcomes were collected and analyzed using SPSS software (version 20). Overall survival (OS) and progression-free survival (PFS) were evaluated using Kaplan-Meier curves.

Results: The annual incidence was 6 new cases per year. The mean age of patients was 32 years (range: 15–61 years), with cryptorchidism present in 31.25% of cases. Scrotal swelling (80%) and pain (30%) were the most common symptoms. Disease stages at diagnosis were stage I (16%), stage II (10%), and stage III (22%). According to the International Germ Cell Cancer Collaborative Group (IGCCCG) classification, 68% of seminomatous germ cell tumors (SGCTs) had a favorable prognosis, while 50% of non-seminomatous germ cell tumors (NSGCTs) had an unfavorable prognosis. The BEP regimen (Bleomycin, Etoposide, Cisplatin) was the primary first-line treatment, achieving complete remission in 31.25% of patients. Disease progression occurred in 18.8% of cases, requiring second-line chemotherapy (TIP, BEP, or VIP). Six deaths were reported, all in stage III patients. After a median follow-up of 4 years, OS was 90% and PFS was 60% across all histologies. SGCTs showed superior outcomes (OS: 91% PFS: 86%) compared to NSGCTs (OS: 85% PFS: 80%).

Conclusion: This study highlights the excellent prognosis of TGCTs, particularly SGCTs, when managed according to international guidelines. High survival rates, even in advanced stages, underscore the effectiveness of modern therapeutic strategies. However, challenges such as delayed diagnosis and limited access to fertility preservation remain areas for improvement. These findings contribute to the growing body of evidence on TGCT management in low- and middle-income countries.