Risk-adapted management in stage I testicular germ-cell tumors: long-term outcomes from a single-center cohort (1994–2023)

Abstract Background Testicular cancer achieves very high cure rates, and current management aims to preserve these outcomes while minimizing treatment-related toxicity. This study aims to describe long-term outcomes of a risk-adapted program for clinical stage I (CSI) testicular germ-cell tumors (TGCT) and to evaluate histopathologic predictors of relapse. Methods Single-center retrospective cohort (1994–2023) of CSI TGCT. Endpoints were relapse, progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). Associations were tested using Cox and Fisher’s exact test; model performance was assessed by discrimination with Harrell’s C-index and 5-year calibration. Results We retrospectively analyzed 277 selected patients with TGCT, of whom 169 (61%) had CSI disease (seminoma = 104; NSGCT = 65; median age 32 years). Initial management was surveillance in 52.1% and adjuvant chemotherapy in 46.2% (carboplatin in seminoma, BEP in NSGCT). After a median follow-up of 87 months, 17 relapses occurred (10.1%). Adjuvant chemotherapy significantly reduced relapse risk (HR 0.20; p = 0.012). Ten-year OS and CSS were 94.4% and 99.3%, respectively. In surveillance-managed seminoma ( n = 54), rete testis invasion independently predicted relapse (HR 9.54, 95% CI 1.29–70.3; p = 0.027), while the Boorman’s classification distinguished intermediate- from low-risk patients (31.8% vs 6.5%; p = 0.04). In NSGCT under surveillance, relapse occurred in a single patient with lymphovascular invasion (1/3, 33.3%) and in 4/31 (12.9%) without; none relapsed after adjuvant BEP. Conclusions Risk-adapted management provides excellent long-term survival in CSI TGCT. Selective adjuvant therapy effectively prevents relapse, while histopathologic risk stratification supports individualized, deescalated strategies.