Abstract Code: IUC26561-85

Real-World Outcomes of Testicular Germ Cell Tumors in Pakistan: A Retrospective Study from A Tertiary Care Center

1. Sundas ¹, S.B. Ahmed ², M. Afzal ¹, Y. Abdul Rashid ¹

(1) Department of Medical Oncology, Aga Khan University Hospital, Karachi – Pakistan, (2) Department of Anatomy, Bahria University Medical and Dental College, Karachi – Pakistan

Background: Testicular germ cell tumors (GCTs) are rare, but they persist as the most common malignancy in males aged between 15 and 44 years. Most of the testicular tumors are gonadal; a small portion are extra-gonadal. The testicular GCTs susceptible to platinum-based chemotherapy are considered to be the most curable ones in early-stage disease and even in advanced disease. The data on outcomes, influence of clinical factors, histologic subtypes, prognosis, and serum markers (AFP, βHCG, LDH), remain scarce in Pakistan, prompting the basis of the present study. 

Methods: This was a retrospective observational study. The Patients above 18 years with a histopathological diagnosis of GCT from 2020 to 2024 were included. The patient demographics, tumor histology, location, stage, tumor markers, and treatment details were recorded. Survival outcomes were analyzed using Kaplan-Meier curves. Cox proportional hazards regression was used to identify independent prognostic factors.

Results:  A total of 73 male patients were included. The mean age was 33 years. Seminoma was the most common tumor type (49.3%). The majority of tumors were of gonadal origin (91.8%) and good-risk (67.1%). BEP was the predominant chemotherapy regimen (49.3%), and orchidectomy was done in 78.1%. Recurrence or progression occurred in 15.1% of the patients. The mean PFS was 58 months (95% CI: 55.7–83.1 months) and the mean OS was 58.76 months (95% CI: 54.39–63.13 months). The median OS could not be estimated as more than half of the cohort remained alive at the end of the study period. On univariate analysis, elevated post-orchidectomy tumor markers were associated with inferior PFS (HR 4.17, 95% CI 1.59–10.95, p = 0.004) and OS (HR 2.70, 95% CI 1.34–5.44, p = 0.006). Risk stratification was significantly associated with OS (HR 2.53, 95% CI 1.06–6.05, p = 0.037).

Conclusion: GCTs at our institute demonstrated favorable long-term outcomes consistent with the established high curability of these tumors. Post-orchidectomy tumor markers emerged as the most important prognostic factor, underscoring their clinical utility in risk assessment. These findings provide a valuable baseline for GCT outcomes in Pakistan and help improve prognostic and management strategies in LMICs.