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Demirci A, Başar H. Effects of epidemiological risk factors on prognosis in testicular cancer. Int Urol Nephrol 2023; 55:51-59. [PMID: 36103044 DOI: 10.1007/s11255-022-03359-2] [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: 06/24/2022] [Accepted: 08/25/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Testicular cancer is frequently seen, especially in young males, and constitutes 1% of all male cancers. Family history, testicular dysgenesis syndrome, and the presence of tumour in the contralateral testis are each well-defined epidemiological risk factors. The aim of the current study was to determine the distribution of these risk factors according to tumour stage and to evaluate the effects on progression. MATERIALS AND METHODS A total of 71 patients diagnosed with testicular cancer in our clinic between January 2018 and December 2021 were classified according to tumour stage (Group 1: Early, n = 29; Group 2: Advanced, n = 42). The presence of risk factors, and demographic and pathological data were recorded. RESULTS No significant difference was determined between the groups in respect of age, comorbidities, and tumour type (p > 0.05). There was no difference between Group 1 and Group 2 in terms of median follow-up time [15.5 (17.5), 16.5(26.5) months, respectively, p = 0.4]. Epidemiological risk factors were seen more in Group 2 than in Group 1 (p = 0.03). Progression-free survival was determined to be shorter in patients with risk factors compared to those without (7.95 ± 1.3 vs. 29.4 ± 2.06 months, p < 0.001, respectively). Family history and testicular dysgenesis syndrome were determined to be independent risk factors for progression [HR:0.046 (0.004-0.485); HR:0.101 (0.03-0.347), p < 0.05, respectively]. CONCLUSIONS More advanced-stage tumours are seen in patients with testicular cancer when epidemiological risk factors are also present. Of these risk factors, family history and testicular dysgenesis syndrome have a negative effect on progression.
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Affiliation(s)
- Aykut Demirci
- Department of Urology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey.
| | - Halil Başar
- Department of Urology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
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2
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Rajpert‐De Meyts E, Jørgensen N, Petersen JH, Almstrup K, Aksglaede L, Lauritsen J, Rørth M, Daugaard G, Skakkebæk NE. Optimized detection of germ cell neoplasia in situ in contralateral biopsy reduces the risk of second testis cancer. BJU Int 2022; 130:646-654. [PMID: 35575005 PMCID: PMC9796833 DOI: 10.1111/bju.15774] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate whether optimized and standardized diagnostic procedures would improve detection of germ cell neoplasia in situ (GCNIS) in the contralateral testis of patients with testicular germ cell tumour (TGCT) and decrease the rate of metachronous tumours, which in a nationwide Danish study was estimated to be 1.9%. PATIENTS AND METHODS This was a retrospective analysis of outcomes in 655 patients with TGCT who underwent contralateral biopsies (1996-2007) compared with those in 459 non-biopsied TGCT controls (1984-1988). The biopsies were performed using a standardized procedure with immunohistochemical GCNIS markers and assessed by experienced evaluators. Initial histopathology reports were reviewed, and pathology and survival data were retrieved from national Danish registers. In 604/608 patients diagnosed as GCNIS-negative (four were lost to follow-up), the cumulative incidence of metachronous TGCT was estimated in a competing risk setting using the Grey method. All cases of metachronous TGCT were re-examined using immunohistochemistry. RESULTS Germ cell neoplasia in situ was found in 47/655 biopsied patients (7.2%, 95% confidence interval [CI] 5.4-9.5%). During the follow-up period (median 17.3 years) five of the 604 GCNIS-negative patients developed a TGCT. In 1/5 false-negative biopsies, GCNIS was found on histological revision using immunohistochemistry and 2/5 biopsies were inadequate because of too small size. The estimated cumulative incidence rate of second tumour after 20 years of follow-up was 0.95% (95% CI 0.10%-1.8%) compared with 2.9% (95% CI 1.3%-4.4%) among the non-biopsied TGCT patients (P = 0.012). The estimates should be viewed with caution due to the small number of patients with metachronous TGCT. CONCLUSIONS Optimized diagnostic procedures improved the detection rate of GCNIS in patients with TGCT and minimized their risk of developing metachronous bilateral cancer. Urologists should be aware of the importance of careful tissue excision (to avoid mechanical compression) and the need of adequate biopsy size. Performing contralateral biopsies is beneficial for patients' care and should be offered as a part of their management.
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Affiliation(s)
- Ewa Rajpert‐De Meyts
- Department of Growth and ReproductionCopenhagen University HospitalRigshospitaletCopenhagen
| | - Niels Jørgensen
- Department of Growth and ReproductionCopenhagen University HospitalRigshospitaletCopenhagen
| | | | - Kristian Almstrup
- Department of Growth and ReproductionCopenhagen University HospitalRigshospitaletCopenhagen
| | - Lise Aksglaede
- Department of Growth and ReproductionCopenhagen University HospitalRigshospitaletCopenhagen
| | - Jakob Lauritsen
- Department of OncologyCopenhagen University HospitalRigshospitaletCopenhagenDenmark
| | - Mikael Rørth
- Department of OncologyCopenhagen University HospitalRigshospitaletCopenhagenDenmark
| | - Gedske Daugaard
- Department of OncologyCopenhagen University HospitalRigshospitaletCopenhagenDenmark
| | - Niels E. Skakkebæk
- Department of Growth and ReproductionCopenhagen University HospitalRigshospitaletCopenhagen
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3
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Shrem NS, Wood L, Hamilton RJ, Kuhathaas K, Czaykowski P, Roberts M, Matthew A, Izard JP, Chung P, Nappi L, Jones J, Soulières D, Aprikian A, Power N, Canil C. Testicular cancer survivorship: Long-term toxicity and management. Can Urol Assoc J 2022; 16:257-272. [PMID: 35905486 PMCID: PMC9343164 DOI: 10.5489/cuaj.8009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Noa Shani Shrem
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Lori Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Robert J. Hamilton
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kopika Kuhathaas
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Piotr Czaykowski
- Department of Medical Oncology and Hematology, CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Matthew Roberts
- Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Andrew Matthew
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jason P. Izard
- Departments of Urology and Oncology, Queen’s University, Kingston, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Health Network, University of Toronto, Toronto, ON, Canada
| | - Lucia Nappi
- Division of Medical Oncology, British Columbia Cancer - Vancouver Cancer Centre, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Jones
- Department of Supportive Care, Princess Margaret Cancer Centre, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Denis Soulières
- Division of Medical Oncology/Hematology, Le Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Armen Aprikian
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Nicholas Power
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Christina Canil
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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Abstract
PURPOSE OF REVIEW Testicular germ cell tumours (TGCTs) are the most common solid malignant cancer diagnosed in young males and the incidence is increasing. Understanding the genetic basis of this disease will help us to navigate the challenges of early detection, diagnosis, treatment, surveillance, and long-term outcomes for patients. RECENT FINDINGS TGCTs are highly heritable. Current understanding of germline risk includes the identification of one moderate-penetrance predisposition gene, checkpoint kinase 2 (CHEK2), and 78 low-to-moderate-risk single nucleotide polymorphisms identified in genome-wide-associated studies, which account for 44% of familial risk. Biomarker research in TGCTs has been challenging for multiple reasons: oncogenesis is complex, actionable mutations are uncommon, clonal evolution unpredictable and tumours can be histologically and molecularly heterogeneous. Three somatic mutations have thus far been identified by DNA exome sequencing, exclusively in seminomas: KIT, KRAS and NRAS. Several genetic markers appear to be associated with risk of TGCT and treatment resistance. TP53 mutations appear to be associated with platinum resistance. MicroRNA expression may be a useful biomarker of residual disease and relapse in future. SUMMARY The biology of testicular germ cells tumours is complex, and further research is needed to fully explain the high heritability of these cancers, as well as the molecular signatures which may drive their biological behaviour.
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Oldenburg J, Berney DM, Bokemeyer C, Climent MA, Daugaard G, Gietema JA, De Giorgi U, Haugnes HS, Huddart RA, Leão R, Sohaib A, Gillessen S, Powles T. Testicular seminoma and non-seminoma: ESMO-EURACAN Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2022; 33:362-375. [PMID: 35065204 DOI: 10.1016/j.annonc.2022.01.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/17/2021] [Accepted: 01/05/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - D M Berney
- Department of Cellular Pathology, Barts Cancer Institute, Queen Mary University of London, London; Barts Health NHS Trust, London, UK
| | - C Bokemeyer
- Department of Oncology, Hematology, Bone Marrow Transplantation with section Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M A Climent
- Fundacion Instituto Valenciano de Oncología, València, Spain
| | - G Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - J A Gietema
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - U De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST),'Dino Amadori', Meldola, Italy
| | - H S Haugnes
- Department of Oncology, University Hospital of North Norway and UiT-The Arctic University, Tromsoe, Norway
| | - R A Huddart
- Institute of Cancer Research and Royal Marsden Foundation Trust, London, UK
| | - R Leão
- Department of Urology, Hospital de Braga, Hospital CUF Coimbra, Faculty of Medicine University of Coimbra, Coimbra, Portugal
| | - A Sohaib
- Department of Diagnostic Radiology, Royal Marsden Hospital, Sutton, Surrey, UK
| | - S Gillessen
- Oncology Institute of Southern Switzerland, EOC, Bellinzona; Faculty of Biomedical Sciences, USI, Lugano, Switzerland; Division of Cancer Medicine, University of Manchester, Manchester
| | - T Powles
- Barts Health NHS Trust, London, UK
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Turco F, Tucci M, Di Stefano RF, Samuelly A, Bungaro M, Bollito E, Scagliotti GV, Buttigliero C. Are tyrosine kinase inhibitors an effective treatment in testicular metastases from kidney cancer? Case report. TUMORI JOURNAL 2021; 107:NP149-NP154. [PMID: 34761706 DOI: 10.1177/03008916211059230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Testicular metastases from renal cell carcinoma (RCC) are extremely rare. Tyrosine kinase inhibitors (TKI) are the cornerstone of systemic therapy for metastatic RCC. We report a case of testicular metastasis in a 72-year-old patient with RCC that developed 17 years after nephrectomy and response to TKI treatment, a retrospective literature search on testicular metastases from RCC, and the indirect evidence described in the literature on the efficacy of chemotherapy and target therapy on testicular lesions.
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Affiliation(s)
- Fabio Turco
- Department of Oncology, University of Turin, at Division of Medical Oncology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Marcello Tucci
- Medical Oncology Department, Cardinal Massaia Hospital, Asti, Italy
| | - Rosario Francesco Di Stefano
- Department of Oncology, University of Turin, at Division of Medical Oncology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Alessandro Samuelly
- Department of Oncology, University of Turin, at Division of Medical Oncology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Maristella Bungaro
- Department of Oncology, University of Turin, at Division of Medical Oncology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Enrico Bollito
- Department of Pathology, University of Turin, at Division of Medical Oncology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Giorgio Vittorio Scagliotti
- Department of Oncology, University of Turin, at Division of Medical Oncology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Consuelo Buttigliero
- Department of Oncology, University of Turin, at Division of Medical Oncology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
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Late toxicities and recurrences in patients with clinical stage I non-seminomatous germ cell tumours after 1 cycle of adjuvant bleomycin, etoposide and cisplatin versus primary retroperitoneal lymph node dissection - A 13-year follow-up analysis of a phase III trial cohort. Eur J Cancer 2021; 155:64-72. [PMID: 34371444 DOI: 10.1016/j.ejca.2021.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/20/2021] [Accepted: 06/14/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND One cycle of adjuvant chemotherapy with bleomycin, etoposide and cisplatin (BEP) has shown superiority in recurrence-free survival over retroperitoneal lymph node dissection (RPLND) in patients with clinical stage (CS) I non-seminomatous germ cell tumours (NSGCTs) of the testis in the setting of a phase III trial. We report the recurrences and late toxicities of this study after 13 years of follow-up. METHODS Questionnaires from 382 patients with CS I NSGCT treated with 1 cycle of adjuvant BEP (arm A) or RPLND + two cycles of adjuvant BEP in cases of pathological stage II disease (arm B) were evaluated regarding recurrences and late toxicity. Overall, information on recurrence status was available in 337 patients, and 170 questionnaires were evaluable for toxicity (arm A: 95; arm B: 75). RESULTS With a median follow-up of 13.8 years (0-22), 3 patients (1.6%) in arm A and 16 patients (8.4%) in arm B experienced recurrence. The 15-year PFS in arm A/B was 99% (CI 96-100%)/92% (CI 89-99%) (p = 0.0049). The 15-year OS in arm A/B was 93% (CI 87-97%)/93% (CI 86-97%) (p = 0.83). Eight patients (4.2%) in arm A and four patients (2.1%) in arm B showed metachronous secondary testicular cancer (p = 0.26). Five patients (2.6%) in arm A and four patients (2.1%) in arm B developed other malignancies. Toxicities were not significantly different apart from retrograde ejaculation, which occurred more frequently after RPLND (10% versus 24%, p = 0.01). CONCLUSIONS With long-term observation, one cycle of BEP remains superior to RPLND in preventing recurrence and was tolerated without any clinically relevant long-term toxicities.
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8
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D'souza A, Van Veldhuizen P, Fung C. Surviving Testicular Cancer: The Role of the Contralateral Testicle. J Clin Oncol 2021; 39:265-268. [PMID: 33503392 DOI: 10.1200/jco.20.03333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anishka D'souza
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Peter Van Veldhuizen
- Division of Hematology, Oncology Department of Medicine, University of Rochester School of Medicine and Dentistry, James P. Wilmot Cancer Institute, Rochester, NY
| | - Chunkit Fung
- Division of Hematology, Oncology Department of Medicine, University of Rochester School of Medicine and Dentistry, James P. Wilmot Cancer Institute, Rochester, NY
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