Can Factors Predicting Malignancy in Intratesticular Masses with Negative Tumor Markers Prevent Overtreatment?

Objective: There is a need for additional predictive factors for the malignant/benign differentiation to prevent overtreatment in intratesticular mass lesions with negative tumor markers. In this study, we evaluated the usability of systemic inflammatory markers, neutrophil-to-lymphocyte ratio (NLR), and tumor in the preoperative differentiation of benign and malignant intratesticular mass lesions. Methods: The records of patients who underwent radical inguinal orchiectomy with a preliminary diagnosis of testicular tumor between August 2007 and September 2020 were retrospectively reviewed. Patients with a malignant specimen histopathology result after radical orchiectomy were classified as group 1, and those with a benign pathology result were classified as group 2. The demographic data, tumor diameters, preoperative systemic inflammatory markers, and NLRs were statistically compared between the two groups. NLR was calculated by dividing the neutrophil count by the lymphocyte count.Results: The study included a total of 78 patients, of whom 47 (60.3%) were in group 1 and 31 (39.7%) were in group 2. The mean tumor sizes of groups 1 and 2 were 3.74 +/- 2.24 cm and 1.87 +/- 1.30 cm, respectively, being significantly higher in group 1 (p<0.001). For groups 1 and 2, the mean white blood cell (WBC) counts were determined as 8.60 +/- 2.23 and 7.54 +/- 2.02 mu/L, respectively; the mean neutrophil counts as 5.30 +/- 1.77 and 4.34 +/- 1.40 mu/L, respectively; the mean neutrophil ratios as 63.0 +/- 8.22 and 56.9 +/- 7.28%, respectively; the mean lymphocyte ratios as 26.2 +/- 6.69 and 31.9 +/- 6.05%, respectively; and the mean NLR values as 2.72 +/- 1.44 and 1.87 +/- 0.54, respectively. The mean WBC count, neutrophil count, neutrophil ratio, and NLR were significantly higher in group 1 (p=0.037, p=0.014, p<0.001, and p=0.002, respectively), and the mean lymphocyte ratio was significantly higher in group 2 (p<0.001). The analysis of the pathological results showed that malignancy correlated positively with tumor size, WBC count, neutrophil count, neutrophil ratio, and NLR, and a negative correlation with the lymphocyte ratio. Conclusion: Tumor diameter, WBC count, neutrophil count, neutrophil ratio, lymphocyte ratio, and NLR can be used as predictive factors in the differentiation of benign-malignant intratesticular masses with negative testicular cancer markers before radical orchiectomy to prevent overtreatment. While the increased values of tumor diameter, WCB count, neutrophil count, neutrophil ratio, and NLR correlate with the possibility of malignancy, a decreased lymphocyte ratio can be evaluated in favor of malignancy.