Researchers have developed a new test capable of identifying which patients are at greatest risk of suffering a relapse from testicular cancer. The test, which involves assessing three features of a testicular cancer tumor, could be used to help clinicians decide on the proper form of follow-up care.

“Our research has led to the development of a test that can detect patients that will benefit from treatment up front and spare those who are at lower risk from the side effects of chemotherapy,” said Janet Shipley, professor of cancer molecular pathology at The Institute of Cancer Research, London, in a press release.

Even if there is no evidence of a tumor spreading, the test can give patients a score that tells them how likely they are to relapse within two years. It’s highly unusual to suffer a relapse outside of this time frame. Researchers tested levels of CXCL12, an antimicrobial gene; the percentage of the tumor showing cancer stem cells; and whether or not blood vessels were present in the tumor. After scoring 177 tumor samples, the team divided up the patients into three different risk groups.

The majority of the patients tested were in the low-risk group, where 94.3 percent of patients did not relapse within two years. The moderate risk group saw 65.9 percent of patients stay relapse-free within the same time, while the high-risk group only had a dismal 30 percent of patients remain relapse-free. The researchers validated the test with an additional 80 patients after the initial study.

Testicular germ cell tumors are the most common solid malignant tumor in young Caucasian men. Properly identifying who would benefit from chemotherapy is a huge step forward in the treatment of these tumors.

“Chemotherapy is extremely effective in treating testicular cancer, but it can have long-term consequences for a patient’s health and wellbeing,” Shipley said. “Patients deemed at low risk of relapse could simply be monitored, and potentially could avoid chemotherapy.”

Shipley said avoiding chemotherapy (if possible) is particularly important for cancers like this, since they would affect young adults who would have to live with chemotherapy side effects for many years after treatment.

Robert Huddart, professor of urological cancer at the Institute of Cancer Research, London, and a consultant at The Royal Marsden NHS Foundation trust, said patients with this kind of germ cell tumor have to make a difficult choice between being monitored or receiving chemotherapy to reduce the risk of relapse.

“Our study may help men make this decision as among the three groups of patients identified, we have found one with a very low risk of relapse where surveillance would seem the best choice, and a small group of men who have a very high risk of relapse, who could be targeted with chemotherapy,” he said. “We now need to test this prognostic index in larger groups of men in the clinic.”

Source: Gilbert D, Al-Saadi R, Thway K, Chandler I, Berney D, Shipley J, et al. Defining a New Prognostic index for Stage I Non-seminomatous Germ Cell Tumors using CXCL12 Expression and Proportion of Embyronal Carcinoma. Clinical Cancer Research. 2015.