Metabolic profile and skeletal muscle as predictors of survival in testicular germ cell tumors.

BACKGROUND

Testicular germ cell tumors (TGCT) are highly curable malignancies, yet the prognostic impact of host metabolic status remains underexplored, especially in non-Caucasian populations.

METHODS

We analyzed 2755 Mexican patients with TGCT treated at the Instituto Nacional de Cancerología (2007-2021). A Metabolic sub-cohort (n = 586) and an Imaging sub-cohort (n = 231) with baseline CT-derived lean mass index (LMI) were evaluated. Statistical analyses included multivariate Cox regression adjusted for IGCCCG risk, principal component analysis (PCA)-based clustering, and internal validation using bootstrapping.

RESULTS

Multivariate Cox regression adjusted for IGCCCG risk identified LMI (HR 0.95, 95% CI 0.90-0.99, P = .047), serum albumin (HR 0.27, 95% CI 0.18-0.42, P < .001), and HDL cholesterol (HR 0.94, 95% CI 0.91-0.96, P < .001) as independently associated factors. PCA-based metabolic-nutritional risk profiles effectively stratified 5-year survival in patients with non-seminoma (from 16.1% in depleted profiles to 97.4% in preserved profiles) and seminoma (64.0% vs 100%). A reduced prognostic model (BMI, LMI, albumin) achieved a robust optimism-corrected AUC of 0.866.

CONCLUSIONS

Metabolic and body composition profiling provides prognostic discrimination complementary to the IGCCCG classification, suggesting the potential utility of incorporating objective nutritional assessments. Early identification of patients with metabolic vulnerability-specifically hypoalbuminemia, skeletal muscle depletion, and altered lipid profiles-could help guide personalized supportive strategies prioritizing nutritional and medical optimization to improve outcomes in TGCT.