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Schnell-Inderst P, Laschkolnig A, Marckmann G, Antony D, Siebert U, Mühlberger N. [Testicular Cancer Screening in Men Aged 16 Years and Older: IQWiG ThemenCheck Health Technology Assessment Report on Medical, Economic, Social, Ethical, Legal and Organisational Aspects]. DAS GESUNDHEITSWESEN 2023; 85:234-241. [PMID: 34872119 PMCID: PMC11248508 DOI: 10.1055/a-1658-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Testicular cancer occurs mainly in young men between 25 and 45 years and is the most common cancer at this age. Possible testicular cancer early detection measures, clinical palpation and scrotal ultrasound (CUS) or testicular self-examination (TSE) in asymptomatic men aged 16 years and older, could perhaps avoid deaths and aggressive late therapies. Therefore, we investigated whether these measures have an additional benefit compared to the current situation. Ethical, legal, social and organisational aspects were considered as well. METHODS The methodology of this review follows IQWiG's "Allgemeine[n] Methoden Version 5.0". In addition, to estimate the theoretically possible benefits and potential harms of screening, a supplementary presentation was used for the benefit assessment based on published data from tumour registries and data on predictive values from diagnostic studies. RESULTS No intervention studies were identified, therefore evidence-based statements on additional benefit or harm of the studied interventions could not be made. The epidemiological data showed that per 100,000 men participating in screening annually, a maximum of 1.2 advanced tumours and 0.4 deaths would have been preventable. Harm calculations suggest that with CUS of 100,000 men, 1 to 22 unnecessary testicular exposures or removals might be expected, with TSE it would be 2 cases. However, these data on the possible harm of screening are subject to great uncertainty. CONCLUSIONS There are no intervention studies demonstrating that the benefit of testicular cancer screening in men aged 16 years and older outweighs the harm. The maximum possible additional benefit is low and chances of detection and cure are good even without screening. At present, testicular cancer screening cannot be recommended.
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Affiliation(s)
- Petra Schnell-Inderst
- Dept. of Public Health, Health Services Research and Health Technology
Assessment, UMIT – University for Health Sciences, Medical Informatics
and Technology, Hall i.T, Österreich
| | | | - Georg Marckmann
- Institut für Ethik, Geschichte und Theorie der Medizin,
Ludwig-Maximilians-Universität München, München,
Deutschland
| | | | - Uwe Siebert
- Dept. of Public Health, Health Services Research and Health Technology
Assessment, UMIT – University for Health Sciences, Medical Informatics
and Technology, Hall i.T, Österreich
- Center for Health Decision Science, Department of Health Policy and
Management, Harvard T.H. Chan School of Public Health, Boston, MA,
USA
- Institute for Technology Assessment and Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Boston, MA,
USA
| | - Nikolai Mühlberger
- Dept. of Public Health, Health Services Research and Health Technology
Assessment, UMIT – University for Health Sciences, Medical Informatics
and Technology, Hall i.T, Österreich
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Carbonnaux M, Vinceneux A, Peyrat P, Fléchon A. [Treatment of testicular germ cell tumors relapse]. Bull Cancer 2020; 107:912-924. [PMID: 32653158 DOI: 10.1016/j.bulcan.2020.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/05/2020] [Accepted: 03/25/2020] [Indexed: 11/17/2022]
Abstract
Seminomatous (SGCT) and non-seminomatous (NSGCT) germ cell tumors (GCT) are rare but their incidence are increasing. We will discuss different therapeutic strategies in relapse disease: patients with stage I germ cell tumor have an excellent prognosis with a cure rate approaching 98-99 %, whatever the histology and the chosen treatment (surveillance strategy or adjuvant treatment). Relapses are observed among 20% of patients with stage I SGCT or low risk NSGCT and 50 % of patients with high risk NSGCT. Patients are treated according to the international prognosis group (IGCCCG) for SGCT and low risk NSGCT, naïve of chemotherapy. After an adjuvant treatment, the protocol must be adapted to the number of previous cycles (1 or 2 BEP) and to the prognosis group. Five to 50% of patients relapse after a first line of metastatic chemotherapy according to initial prognosis group. Dose-dense chemotherapy according to the GETUG13 protocol reduces the risk of relapse for the patients with poor-risk group NSGCT and unfavorable tumor marker decline. The prognosis of patients with relapsed or refractory GCT after a first line is more negative since only half of them will be cured by salvage standard chemotherapy. An international therapeutic trial (TIGER) is ongoing in first line salvage treatment evaluating high-dose chemotherapy (HDCT) with hematopoietic stem cell transplantation (HSCT). Finally, developing biomarkers for predicting clinical relapse, the management in expert centers of these patients and participation in therapeutic innovation are important perspectives for a better understanding and treatment of these patients with a poorer prognosis.
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Affiliation(s)
- Mélodie Carbonnaux
- Département d'oncologie médicale, centre Léon-Bérard, 28, rue Laennec, 69337 Lyon cedex 08, France.
| | - Armelle Vinceneux
- Département d'oncologie médicale, centre Léon-Bérard, 28, rue Laennec, 69337 Lyon cedex 08, France
| | - Patrice Peyrat
- Département de chirurgie, centre Léon-Bérard, 28, rue Laennec, 69337 Lyon cedex 08, France
| | - Aude Fléchon
- Département d'oncologie médicale, centre Léon-Bérard, 28, rue Laennec, 69337 Lyon cedex 08, France
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Abstract
PURPOSE OF REVIEW Testicular germ cell tumour (TGCT) is a common malignancy among young men. There is controversy regarding the best approach for patients with clinical stage I disease due to rates of relapse with active surveillance in contrast to overtreatment with adjuvant therapy. The aim of this review is to describe the role of prognostic factors in this setting. RECENT FINDINGS Molecular prognostic factors have been described as a possible future aid to clinical and histologic features in the approach of patients with clinical stage I germ cell tumours. SUMMARY Prognostic factors currently available are not accurate enough and may lead to overtreatment. However, though active surveillance has shown long-term survival near to 100% in the management of clinical stage I germ cell tumours, there is a significant percentage of patients with occult metastatic disease, who benefit from adjuvant therapy. In light of these data, future research is needed to better define high-risk patients for relapse, taking into account molecular markers recently reported.
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Knežević N, Kuliš T, Penezić L, Ćorić M, Krhen I, Kaštelan Ž. OCT4 immunohistochemistry after staging laparoscopic retroperitoneal lymphadenectomy for testicular tumor. Acta Clin Croat 2019; 58:343-347. [PMID: 31819332 PMCID: PMC6884368 DOI: 10.20471/acc.2019.58.02.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Twenty to thirty percent of patients with clinical stage I testicular tumor have metastases in the retroperitoneum. The aim of this study was to evaluate the role of OCT4 immunohistochemistry in histopathologic diagnosis of lymph node metastases in patients with nonseminomatous germ cell testicular tumors. All clinical stage I patients with staging laparoscopic retroperitoneal lymphadenectomy from 2001 until 2009 were included. Archived materials of dissected lymph nodes were reassessed and additional immunohistochemical staining with OCT4 antibody was performed in patients diagnosed as free from metastases. Each slide was visually estimated for the percentage of tumor cells showing nuclear immunoreactivity for OCT4. The study included 93 patients, of which 30 (32.3%) had initially positive retroperitoneal lymph nodes. Of the remaining 63 patients, materials were missing for 5 patients, so additional immunohistochemical staining was performed in 58 patients. Of these, two (3.4%) patients were OCT4 positive, suggesting a conclusion that they were initially misdiagnosed as stage I and metastasis free. OCT4 proved its value in detecting retroperitoneal metastases. Staging laparoscopic retroperitoneal lymphadenectomy for nonseminomatous germ cell testicular tumors in clinical stage I is a reasonable option for selected patients.
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Affiliation(s)
| | - Tomislav Kuliš
- 1Department of Urology, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Pathology and Cytology, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Luka Penezić
- 1Department of Urology, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Pathology and Cytology, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Marijana Ćorić
- 1Department of Urology, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Pathology and Cytology, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivan Krhen
- 1Department of Urology, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Pathology and Cytology, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Željko Kaštelan
- 1Department of Urology, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Pathology and Cytology, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia
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Decision analysis defining optimal management of clinical stage 1 high-risk nonseminomatous germ cell testicular cancer with lymphovascular invasion. Urol Oncol 2018; 36:342.e1-342.e6. [PMID: 29754945 PMCID: PMC10182405 DOI: 10.1016/j.urolonc.2018.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/22/2018] [Accepted: 03/30/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Risk of recurrent disease for men with clinical stage 1 high-risk nonseminomatous germ cell testicular cancer (CS1 NSGCT) with lymphovascular invasion (LVI) after orchiectomy is 50% and current treatment options (surveillance [S], retroperitoneal lymph node dissection [RPLND], or 1 cycle of BEP [BEP ×1]) are associated with a 99% disease specific survival, therefore practice patterns vary. We performed a decision analysis using updated data of long-term complications for men with CS1 NSGCT with LVI to quantify and assess relative treatment values. METHODS Decision analysis included previously defined utilities (via standard gamble) for posttreatment states of living from 0 (death from disease) to 1 (alive in perfect health) and updated morbidity probabilities. We quantified the values of S, RPLND, and BEP ×1 via the rollback method. Sensitivity analyses including a range of orchiectomy cure rates and utility values were performed. RESULTS Estimated probabilities favoring treatment with RPLND (0.97) or BEP ×1 (0.97) were equivalent and superior to surveillance (0.88). Sensitivity analysis of orchiectomy cure rates (50%-100%) failed to find a cure rate that favored S over BEP ×1 or RPLND. Varying utility values for cure after S from 0.92 (previously defined utility) to 1 (perfect health), failed to find a viable utility state favoring S over BEP ×1 or RPLND. An orchiectomy cure rate of ≥82% would be required for S to equal treatment of either type. CONCLUSIONS We demonstrate that for surveillance to be superior to treatment with BEP ×1 or RPLND, the orchiectomy cure rate must be at least 82%, which is not expected in a patient population with high-risk CS1 NSGCT.
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Ferraro S, Trevisiol C, Gion M, Panteghini M. Human Chorionic Gonadotropin Assays for Testicular Tumors: Closing the Gap between Clinical and Laboratory Practice. Clin Chem 2018; 64:270-278. [DOI: 10.1373/clinchem.2017.275263] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 09/14/2017] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Clinical practice guidelines recommend the measurement of human chorionic gonadotropin (hCG) and/or hCGβ in serum for management of testicular germ cell tumors (GCTs). These guidelines, however, disregard relevant biochemical information on hCG variants to be detected for oncological application. We set out to provide a critical review of the clinical evidence together with a characterization of the selectivity of currently marketed hCG immunoassays, identifying assays suitable for management of GCTs.
CONTENT
Evidence sources in the available literature were critically appraised. Most instances of misdiagnosis and mismanagement of testicular GCTs have been associated with hCG results. According to the clinical evidence, 36% of patients with seminoma show an exclusive hCGβ increase, and 71% of patients with nonseminomatous GCTs (NSGCTs) show an increase of intact hCG and/or hCG + hCGβ, whereas the hCGβ increase in NSGCTs is variable according to the tumor stage and histology.
SUMMARY
hCG + hCGβ assays that display an equimolar recognition of hCG and hCGβ, or at least do not overtly underestimate hCGβ, may be employed for management of testicular GCTs. Assays that underestimate hCGβ are not recommended for oncological application. In addition to the hCG + hCGβ assay in service, an additional assay with broader selectivity for other hCG variants should be considered when false-negative or false-positive results are suspected on the basis of clinical data.
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Affiliation(s)
- Simona Ferraro
- Department of Biomedical and Clinical Sciences “Luigi Sacco,” University of Milan, and Clinical Pathology Laboratory, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Massimo Gion
- Regional Center and Program for Biomarkers, Department of Clinical Pathology and Transfusion Medicine, Venice, Italy
| | - Mauro Panteghini
- Department of Biomedical and Clinical Sciences “Luigi Sacco,” University of Milan, and Clinical Pathology Laboratory, ASST Fatebenefratelli-Sacco, Milan, Italy
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Harada KI, Miyake H, Ogawa T, Inoue TA, Fujisawa M. Oncological Outcomes in Japanese Men Undergoing Orchiectomy for Stage I Testicular Germ Cell Tumor. Curr Urol 2016; 8:84-90. [PMID: 26889123 DOI: 10.1159/000365695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 06/19/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The objective of this study was to retrospectively review oncological outcomes in patients with stage I testicular germ cell tumor (GCT). PATIENTS AND METHODS This study included 265 consecutive Japanese men undergoing orchiectomy for stage I testicular GCT, and a retrospective review of their records was performed. RESULTS Of these 265 patients, 192 and 73 were pathologically classified with seminoma and nonseminoma, respectively. Prophylactic radiation and chemotherapy were performed in 62 patients with seminoma and 6 with nonseminoma, respectively. Disease recurrence occurred in 12 seminoma patients, of whom 11 had not received prophylactic radiation therapy; however, all 12 achieved a complete response to bleomycin, etoposide and cisplatin therapy. Of the nonseminoma patients, 19 experienced disease recurrence and were then treated with bleomycin, etoposide and cisplatin followed additionally by the surgical resection of residual tumors and salvage chemotherapy in 7 and 4, respectively. There was no cancer-specific death in the 265 patients, and 5-year recurrence-free survival rates in patients with seminoma and nonseminoma were 92.6 and 72.8%, respectively. Furthermore, following factors appeared to be significantly associated with recurrence-free survival in these patients: age, T classification, microvascular invasion and adjuvant therapy for those with seminoma, and microvascular invasion for those with nonseminoma. CONCLUSIONS Despite a generally favorable prognosis in Japanese men with stage I testicular GCT, intensive follow-up or prophylactic therapy should be considered for men with possible risk factors of disease recurrence.
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Affiliation(s)
- Ken-Ichi Harada
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideaki Miyake
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takayoshi Ogawa
- Department of Urology, Himeji Red Cross Hospital, Himeji, Japan
| | - Taka-Aki Inoue
- Department of Urology, Hyogo Cancer Center, Akashi, Japan
| | - Masato Fujisawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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Abstract
Testis cancer represents the model for a curable malignancy. Although there is consensus about the appropriate management of metastatic (clinical stage [CS] IIC-III) nonseminomatous germ cell tumor (NSGCT) in terms of the chemotherapy regimens, number of cycles, and the surgical resection of postchemotherapy residual masses, there remains controversy regarding the appropriate management of low-stage NSGCT (CSI-IIB). In this article, the benefits and drawbacks of each treatment option are reviewed; an evidence-based approach when confronted with such a patient and how to best select a treatment avenue based on the patient's clinical and pathologic features are also discussed.
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Affiliation(s)
- Evan Kovac
- Glickman Urological & Kidney Institute, Cleveland Clinic, Mail Code Q10-1, 9500 Euclid Avenue, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Andrew J Stephenson
- Center for Urologic Oncology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland Clinic Main Campus, Mail Code Q10-1, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Sharma P, Dhillon J, Agarwal G, Zargar-Shoshtari K, Sexton WJ. Disparities in Interpretation of Primary Testicular Germ Cell Tumor Pathology. Am J Clin Pathol 2015; 144:289-94. [PMID: 26185314 DOI: 10.1309/ajcpjtx8r6cvwsrw] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Accurate pathologic interpretation of testicular germ cell tumors (GCTs) can be problematic due to low incidence and variation in histologic patterns. By analyzing changes in the diagnosis of testicular specimens after secondary review, we hoped to determine how these can affect prognosis and treatment. METHODS From 1999 to 2013, a total of 235 patients underwent radical orchiectomy at a referring facility and had pathology specimens reanalyzed by our center's pathologists with expertise in genitourinary malignancies. We identified discrepancies in pathologic reporting. RESULTS Fifty (21.3%) patients had variations in interpretation of their orchiectomy specimens. A clinically significant alteration was identified in 16 (6.8%) patients, most commonly due to recognition (or misrecognition) of lymphovascular invasion (LVI) associated with nonseminomatous germ cell tumors (NSGCTs). Changes in LVI status resulted in upstaging or downstaging from clinical stage 1A to stage 1B or vice versa in six patients with NSGCTs, with a subsequent change in therapeutic strategy. In addition, one patient with stage 1 pure seminoma had been misclassified with nonseminoma. CONCLUSIONS Inaccurate interpretation of orchiectomy specimens is not uncommon and may lead to incorrect tumor staging, imprecise assignment of progression risk, and inappropriate management recommendations. Secondary opinions of primary GCT orchiectomy specimens potentially facilitate appropriate counseling and therapeutic strategies.
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Affiliation(s)
- Pranav Sharma
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Jasreman Dhillon
- Department of Pathology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Gautum Agarwal
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | | | - Wade J. Sexton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
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Coleman S, Stephenson A. Controversies in the Management of Stage 1 Non-Seminomatous Germ Cell Tumors. Curr Urol Rep 2013; 14:506-10. [DOI: 10.1007/s11934-013-0362-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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