Brandt MP, Ruf C, Dieckmann KP, et al. - Of testicular germ cell tumors (TGCT) cases, about 1% were classified as cCSIS (correctly classified clinical stage IS) cases. In order to prevent disease progression and relapses by adequate therapy, detection of cCSIS is of critical importance. A high heterogeneity of treatment patterns was evident, linked with excellent long-term survival regardless of the initial treatment strategy.

• Data from five tertiary referring centers in Germany were screened and correct classification of clinical stage IS (CSIS) by EAU guidelines was defined, to ultimately examine clinical features and oncological outcome in CSIS [defined as persistently elevated tumor markers (TM) after orchiectomy, indicating subclinical metastatic disease].

• There were 2,616 TGCT cases, of those 43 (1.6%) were CSIS; thereof, 27 were accurately classified (cCSIS, 1.03%) and 16 incorrectly classified (iCSIS).

• cCSIS-defining TMs were α-feto protein (AFP), β-human chorionic gonadotropin (β-HCG), AFP plus ß-HCG and lactate dehydrogenase in 12 (44.4%), 10 (37%), 3 (11.1%) and 2 (7.4%) patients, respectively.

• Treatment comprised active surveillance, carboplatin-mono AUC7 and BEP (bleomycin, etoposide and cisplatin).

• In terms of applied chemotherapy, there was no difference between cCSIS and iCSIS.

• Five-year relapse-free survival was noted to be 88.9% and relapse occurred in three patients (11%) in the cCSIS group.

• All had salvage treatment (3xBEP) with no reported death.