{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T04:18:52Z","timestamp":1772165932705,"version":"3.50.1"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,8,20]],"date-time":"2020-08-20T00:00:00Z","timestamp":1597881600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,8,20]],"date-time":"2020-08-20T00:00:00Z","timestamp":1597881600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Urol"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Seminoma accounts for 30\u201350% of testicular germ cell tumors (TGCT)\u2014the most common solid malignancy in men aged 15\u201335\u2009years. The American Joint Committee on Cancer (AJCC) 8th edition (2018) created the subclassifications pT1a (tumor size &lt;\u20093\u2009cm) and pT1b (\u2265 3\u2009cm), despite not being universally recognized.\n                      <jats:italic>Rete testis<\/jats:italic>\n                      invasion (RTI) and tumor size &gt;\u20094\u2009cm are considered features associated with a higher recurrence risk, but not formally used for staging. The authors propose further understanding the subclassification\u2019s potential impact in clinical practice, by summarizing current evidence and reviewing clinical cases in their institutions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All consecutive cases of seminoma stage I, pT1 treated in two institutions between January 2005 and December 2016 were included. Clinical data were retrieved, and variables were analyzed using SPSS. Relevant literature on the topic was reviewed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seminoma pT1 was identified in 58 patients. By using newly AJCC criteria, 29 (50%) would have been staged as pT1a and 29 (50%) pT1b. Median age at diagnosis was similar (33 in pT1a vs 32 in pT1b). Median follow-up time 5.8\u2009years. Almost half (45%) of pT1b patients had a tumor size &lt;\u20094\u2009cm. The majority of either pT1a or pT1b were treated with chemotherapy or radiotherapy, reflecting more intensive approaches in the past. Three retroperitoneal recurrences were recorded (two in pT1a, one in pT1b, all under surveillance protocol); no deaths occurred. RTI and extensive necrosis (EN) were associated with pT1b (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009\u00a00.0001 and\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.023, respectively), known adverse biological features.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In our population, the exploratory analysis of the newly created AJCC criteria showed no significant difference in recurrence or death, although pT1b was associated with adverse biomarkers, such as RTI and EN, but its clinical relevance remains incompletely understood. Our results confirm an excellent prognosis, regardless of subcategorization, thus a larger population and a longer follow-up time are needed to understand prospectively the impact of the recently updated criteria. We would recommend using the latest AJCC staging system, although the individual risk of relapse, long-term toxicities and patient preferences should be taken into account when considering surveillance or active treatment adjuvant options.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12894-020-00682-7","type":"journal-article","created":{"date-parts":[[2020,8,20]],"date-time":"2020-08-20T06:04:07Z","timestamp":1597903447000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Clinical implications of the American Joint Committee on Cancer (AJCC) 8th edition update in seminoma pT1 subclassification"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0337-3251","authenticated-orcid":false,"given":"M\u00e1rio","family":"Fontes-Sousa","sequence":"first","affiliation":[]},{"given":"Jo\u00e3o","family":"Lobo","sequence":"additional","affiliation":[]},{"given":"Helena","family":"Magalh\u00e3es","sequence":"additional","affiliation":[]},{"given":"Jo\u00e3o","family":"Cassis","sequence":"additional","affiliation":[]},{"given":"Mariana","family":"Malheiro","sequence":"additional","affiliation":[]},{"given":"S\u00e2ncia","family":"Ramos","sequence":"additional","affiliation":[]},{"given":"Rui","family":"Henrique","sequence":"additional","affiliation":[]},{"given":"Ana","family":"Martins","sequence":"additional","affiliation":[]},{"given":"Maria Joaquina","family":"Maur\u00edcio","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2020,8,20]]},"reference":[{"key":"682_CR1","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3322\/caac.21332","volume":"66","author":"RL Siegel","year":"2016","unstructured":"Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016: Cancer statistics, 2016. CA Cancer J Clin. 2016;66:7\u201330.","journal-title":"CA Cancer J Clin"},{"key":"682_CR2","volume-title":"AJCC Cancer staging manual","year":"2017","unstructured":"Amin MB, Edge SB, Greene FL, et al., editors. AJCC Cancer staging manual. 8th ed. New York: Springer International Publishing; 2017.","edition":"8"},{"key":"682_CR3","volume-title":"UICC TNM classification of malignant Tumours","year":"2016","unstructured":"Brierlwy JD, Gospodarowicz M, Wittekind C, editors. UICC TNM classification of malignant Tumours. 8th ed. New York: Wiley Blackwell; 2016.","edition":"8"},{"key":"682_CR4","volume-title":"EAU Guidelines on Testicular Cancer","author":"Albers P. (Chair)","year":"2017","unstructured":"Albers P. (Chair). EAU Guidelines on Testicular Cancer. 2017. https:\/\/uroweb.org\/wp-content\/uploads\/11-Testicular-Cancer_2017_web.pdf. Accessed 3 Sep 2018."},{"key":"682_CR5","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1016\/S0305-7372(02)00059-2","volume":"28","author":"MD Shelley","year":"2002","unstructured":"Shelley MD, Burgon K, Mason MD. Treatment of testicular germ-cell cancer: a cochrane evidence-based systematic review. Cancer Treat Rev. 2002;28:237\u201353.","journal-title":"Cancer Treat Rev"},{"key":"682_CR6","doi-asserted-by":"publisher","first-page":"8717","DOI":"10.1200\/JCO.2005.01.9810","volume":"23","author":"J Aparicio","year":"2005","unstructured":"Aparicio J, Germ\u00e0 JR, del Muro XG, Maroto P, Arranz JA, S\u00e1enz A, et al. Risk-adapted Management for Patients with Clinical Stage I Seminoma: the second Spanish germ cell Cancer cooperative group study. J Clin Oncol. 2005;23:8717\u201323.","journal-title":"J Clin Oncol"},{"key":"682_CR7","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1016\/j.eururo.2017.09.025","volume":"73","author":"JL Boormans","year":"2018","unstructured":"Boormans JL, Mayor de Castro J, Marconi L, Yuan Y, Laguna Pes MP, Bokemeyer C, et al. Testicular tumour size and rete testis invasion as prognostic factors for the risk of relapse of clinical stage I seminoma testis patients under surveillance: a systematic review by the testicular Cancer guidelines panel. Eur Urol. 2018;73:394\u2013405.","journal-title":"Eur Urol"},{"key":"682_CR8","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1016\/j.humpath.2018.07.016","volume":"82","author":"J Lobo","year":"2018","unstructured":"Lobo J, Costa AL, Vilela-Salgueiro B, Rodrigues \u00c2, Guimar\u00e3es R, Cantante M, et al. Testicular germ cell tumors: revisiting a series in light of the new WHO classification and AJCC staging systems, focusing on challenges for pathologists. Hum Pathol. 2018;82:113\u201324.","journal-title":"Hum Pathol"},{"key":"682_CR9","doi-asserted-by":"publisher","first-page":"e22","DOI":"10.1097\/PAS.0000000000000844","volume":"41","author":"C Verrill","year":"2017","unstructured":"Verrill C, Yilmaz A, Srigley JR, Amin MB, Comp\u00e9rat E, Egevad L, et al. Reporting and staging of testicular germ cell tumors: the International Society of Urological Pathology (ISUP) testicular Cancer consultation conference recommendations. Am J Surg Pathol. 2017;41:e22\u201332.","journal-title":"Am J Surg Pathol"},{"key":"682_CR10","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1016\/j.juro.2008.04.032","volume":"180","author":"DE Cooper","year":"2008","unstructured":"Cooper DE, L\u2019Esperance JO, Christman MS, Auge BK. Testis Cancer: a 20-year epidemiological review of the experience at a regional military medical facility. J Urol. 2008;180:577\u201382.","journal-title":"J Urol"},{"key":"682_CR11","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1038\/nrurol.2012.59","volume":"9","author":"MV Williams","year":"2012","unstructured":"Williams MV, Mazhar D. Poor trial accrual hinders germ cell tumor therapy advances. Nat Rev Urol. 2012;9:243\u20135.","journal-title":"Nat Rev Urol"},{"key":"682_CR12","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1093\/ajcp\/aqy168","volume":"151","author":"A Farooq","year":"2019","unstructured":"Farooq A, Jorda M, Whittington E, Kryvenko ON, Braunhut BL, Pavan N, et al. Rete testis invasion is consistent with pathologic stage T1 in germ cell tumors. Am J Clin Pathol. 2019;151:479\u201385.","journal-title":"Am J Clin Pathol"},{"key":"682_CR13","doi-asserted-by":"publisher","first-page":"1658","DOI":"10.1093\/annonc\/mdy217","volume":"29","author":"F Honecker","year":"2018","unstructured":"Honecker F, Aparicio J, Berney D, Beyer J, Bokemeyer C, Cathomas R, et al. ESMO consensus conference on testicular germ cell cancer: diagnosis, treatment and follow-up. Ann Oncol. 2018;29:1658\u201386.","journal-title":"Ann Oncol"},{"key":"682_CR14","doi-asserted-by":"publisher","first-page":"4448","DOI":"10.1200\/JCO.2002.01.038","volume":"20","author":"P Warde","year":"2002","unstructured":"Warde P, Specht L, Horwich A, Oliver T, Panzarella T, Gospodarowicz M, et al. Prognostic factors for relapse in stage I seminoma managed by surveillance: a pooled analysis. J Clin Oncol. 2002;20:4448\u201352.","journal-title":"J Clin Oncol"},{"key":"682_CR15","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1111\/his.13200","volume":"71","author":"B Delahunt","year":"2017","unstructured":"Delahunt B, Egevad L, Samaratunga H, Varma M, Verrill C, Cheville J, et al. UICC drops the ball in the 8th edition TNM staging of urological cancers. Histopathology. 2017;71:5\u201311.","journal-title":"Histopathology."},{"key":"682_CR16","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1002\/cam4.324","volume":"4","author":"P Chung","year":"2015","unstructured":"Chung P, Daugaard G, Tyldesley S, Atenafu EG, Panzarella T, Kollmannsberger C, et al. Evaluation of a prognostic model for risk of relapse in stage I seminoma surveillance. Cancer Med. 2015;4:155\u201360.","journal-title":"Cancer Med"},{"key":"682_CR17","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1200\/JCO.2017.76.5610","volume":"36","author":"RAW van de Wetering","year":"2018","unstructured":"van de Wetering RAW, Sleijfer S, Feldman DR, Funt SA, Bosl GJ, de Wit R. Controversies in the Management of Clinical Stage I Seminoma: carboplatin a decade in\u2014time to start backing out. J Clin Oncol. 2018;36:837\u201340.","journal-title":"J Clin Oncol"}],"container-title":["BMC Urology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12894-020-00682-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12894-020-00682-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12894-020-00682-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,19]],"date-time":"2021-08-19T19:24:45Z","timestamp":1629401085000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcurol.biomedcentral.com\/articles\/10.1186\/s12894-020-00682-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,20]]},"references-count":17,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["682"],"URL":"https:\/\/doi.org\/10.1186\/s12894-020-00682-7","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-16748\/v1","asserted-by":"object"},{"id-type":"doi","id":"10.21203\/rs.3.rs-16748\/v2","asserted-by":"object"}]},"ISSN":["1471-2490"],"issn-type":[{"value":"1471-2490","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,20]]},"assertion":[{"value":"14 February 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 July 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 August 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was approved by the Ethics Committee of the Portuguese Oncology Institute of Porto, Portugal (CES-IPO-12-018). No specific administrative authorization was needed to conduct the study according to the best medical and research practices.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable,","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All authors report no conflict of interest regarding this work.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"127"}}