Scandura G, et al. - Age, tumor size, invasion of vessels, hilar soft tissue, rete testis, epididymis, spermatic cord, tunica vaginalis, tumor at spermatic cord margin were evaluated and associated with the clinical stage (CS) at presentation in order to examine pathological predictors of metastatic disease at presentation in 332 testicular seminomas. A total of 290 tumors were CS 1, 42 were CS 2/3. The mean tumor size of CS 1 and CS 2/3 was 38 mm (5–95 mm) and 54 mm (8–95 mm), respectively. On univariate analysis, lymphovascular invasion, epididymal invasion, and tumor size were related to greater CS. On multivariate analysis, tumor size and epididymis invasion continued to be important. The optimal tumor size cut-off was 4.25 cm. In conclusion, the most robust predictors of metastatic disease at presentation are tumor size and epididymal invasion. Moreover, the outcomes confirm variations in American Joint Committee on Cancer TNM staging 8th Edition, though it regards a tumor size of 4 cm as the superior cut-off value.