Independent factors associated with advanced testicular germ cell tumors: the roles of smoking, lymphovascular invasion, and tumor size

BACKGROUND: Testicular germ cell tumors (TGCTs) are the most common solid malignancies among young men. Although overall survival exceeds 95%, a subset of patients still present with advanced disease or relapse. Identifying clinicopathological and modifiable lifestyle factors associated with advanced-stage presentation may improve risk stratification and guide management. METHODS: This retrospective study included 96 patients with TGCTs treated at a single tertiary center. Data on smoking status, body mass index (BMI), lymphovascular invasion (LVI), and tumor size were analyzed. Associations between these parameters and stage at diagnosis were assessed using chi-square tests and multivariable logistic regression. Recurrence-free survival (RFS) was evaluated by the Kaplan-Meier method. RESULTS: Among 96 patients (median age, 31 years), 59.4% had early-stage and 40.6% had advanced-stage disease. Smoking (OR = 8.17; p = 0.014), LVI (OR = 70.23; p < 0.001), and tumor size ≥ 4 cm (OR = 12.00; p = 0.009) were independently associated with advanced-stage presentation, whereas BMI showed no significant association. Recurrence occurred in 13.5% of patients, more frequently among smokers and LVI-positive cases, though not statistically significant. CONCLUSION: Smoking, lymphovascular invasion, and tumor size ≥ 4 cm were independently associated with advanced-stage presentation in TGCTs, whereas obesity showed no significant association. The combined evaluation of pathological and lifestyle factors may enhance individualized risk stratification and inform future risk-adapted management strategies.