Complex analysis of the national Hereditary angioedema cohort in Slovakia - Identification of 12 novel variants in SERPING1 gene

Background

Hereditary angioedema (HAE) is a rare autosomal dominant genetic disease characterised by acute episodes of non-pruritic skin and submucosal swelling caused by increase in vascular permeability.

Objective

Here we present the first complex analysis of the National HAE Slovakian cohort with the detection of 12 previously un-published genetic variants in SERPING1 gene.

Methods

In patients diagnosed with hereditary angioedema caused by deficiency or dysfunction of C1 inhibitor (C1-INH-HAE) based on clinical manifestation and complement measurements, SERPING1 gene was tested by DNA sequencing (Sanger sequencing/massive parallel sequencing) and/or multiplex ligation-dependent probe amplification for detection of large rearrangements.

Results

The Slovakian national cohort consisted of 132 living patients with confirmed HAE. We identified 51 index cases (32 families, 19 sporadic patients/112 adults, 20 children). One hundred seventeen patients had HAE caused by deficiency of C1 inhibitor (C1-INH-HAE-1) and 15 patients had HAE caused by dysfunction of C1 inhibitor (C1-INH-HAE-2). The prevalence of HAE in Slovakia has recently been calculated to 1:41 280 which is higher than average calculated prevalence. The estimated incidence was 1:1360 000. Molecular-genetic testing of the SERPING1 gene found 22 unique causal variants in 26 index cases, including 12 previously undescribed and unreported.

Conclusion

The first complex report about epidemiology and genetics of the Slovakian national HAE cohort expands the knowledge of the C1-INH-HAE genetics. Twelve novel causal variants were present in the half of the index cases. A higher percentage of inframe variants comparing to other studies was observed. Heterozygous deletion of exon 3 found in a large C1-INH-HAE-1 family probably causes the dysregulation of the splicing isoforms balance and leads to the decrease of full-length C1-INH level.

The Checklist for Standard Methodological Requirements and Reporting of Economic Evaluation of Medicines in Slovakia

OBJECTIVES

We have developed a scientifically well-grounded, methodological, and reporting checklist for economic evaluation (EE) of medicines in the Slovak health technology assessment process, which serves as a supplement to the Slovak pharmacoeconomic guidelines.

METHODS

The checklist was developed using an iterative process in which items were generated and gradually added to the baseline checklist based on shortcomings identified in an analysis of Slovak EEs, using relevant published checklists, and Slovak, as well as international, methodological guidance that was identified in the systematic literature review. The selection of checklist recommendations, their clarity, and relevance to the Slovak setting were validated in the online survey.

RESULTS

From the sample of 151 price and reimbursement submissions published between January 2018 and July 2021, almost half of them (n = 73) received at least 1 request from the Ministry of Healthcare to justify or modify the methodology used in the EE; and in 18 proceedings, a negative opinion was issued because of shortcomings identified in the EE. The 25-items preliminary checklist, resulting from an iterative working process, has been validated in an online survey conducted among members of ISPOR Chapter Slovakia. After incorporating relevant comments, the final proposal for the Slovak checklist consists of 55 recommendations.

CONCLUSIONS

The research represented the first attempt to create a Slovak EE checklist, which serves as a part of ISPOR Slovakia pharmacoeconomic guidelines. Implementation of the checklist allows checking whether EE meets legislative and methodological requirements and thus helps in improving the appropriateness and standardization of EEs in Slovakia.

Real-world outcomes of mepolizumab treatment in severe eosinophilic asthma patients - retrospective cohort study in Slovakia

AIMS

Mepolizumab, a fully-humanized recombinant IgG1 kappa monoclonal antibody directed against IL-5, has shown improved asthma control and lung function in randomised controlled trials. The aim of this study was to evaluate real-world clinical experience in patients with severe eosinophilic asthma treated with mepolizumab in Slovakia.

METHODS

A retrospective, non-interventional study based on medical records of all adult asthma patients initiating mepolizumab between November 1, 2017 and January 31, 2019, completing 12 months of treatment. At baseline, general and clinical profile data were recorded 12 months prior to treatment. Primary and secondary endpoints described the results of mepolizumab use at 2, 6, and 12 months after the initiation and compared to baseline. Statistical testing of individual change (in each patient) in selected parameters was performed.

RESULTS

The cohort included 17 patients with particularly severe asthma at baseline, with frequent severe exacerbations (SE, median 5 [IQR 4-6]/patient/year), high blood eosinophil counts (median 0.6x109/L), frequent oral corticosteroid (OCS) dependence (82.35%), median dose 15 (IQR 7.5-20) mg/day, impaired lung function, and a spectrum of comorbidities. In a one-year follow-up, the data showed reductions in median SE (0 [IQR 0-1] patient/year, eosinophilia (median 0.175x109/L) and OCS maintenance dose (median 6.25 [IQR 2.5-20] mg/day), all statistically significant after 12 months on mepolizumab. Improved and stabilised lung functions throughout the cohort and a reduced incidence of nasal polyposis were observed.

CONCLUSIONS

The results provide clinical evidence of mepolizumab efficacy in a real sample of patients with severe asthma when administered in routine care settings in Slovakia.

Lung Cancer Screening Initiative in Slovakia: Guidelines of screening implementation

Lung cancer (LC) represents a major healthcare issue worldwide. It is the leading cause of cancer-related mortality in Slovakia and European Union. Data from multiple randomized controlled trials have shown significant evidence of a mortality benefit in LC using screening with low-dose computed tomography of the chest (LDCT). Therefore, European healthcare authorities, relevant expert societies, and professional organizations recommend implementing national LC screening (LCS) programs in their member countries. This article outlines the basic methodology, guidelines, and practical aspects of LCS implementation strategies in Slovakia. We describe fundamental principles to identify asymptomatic high-risk patients reduce false positive and false negative results, decrease benign resection rates, and avoid unnecessary invasive procedures. The efficacious utilization of public resources to secure the highest possible quality standards of LDCT plays a crucial role in successfully implementing a nationwide LCS program (Tab. 1, Fig. 4, Ref. 31). Text in PDF www.elis.sk Keywords: lung cancer, screening, early detection, smoking cessation.

Bilateral testicular germ cell tumors - 50 years experience

OBJECTIVE

This study analysed the characteristics and outcome of the patients with bilateral germ testicular cell cancer (TC), especially synchronous.

METHODS

Among 2.124 TC patients diagnosed between 1970 and 2020, 96 (4. 5%) developed the 2nd TC. Nine occurred synchronously and 87 were metachronous. Patients were analysed according to the age and histological type of bilateral TC in comparison with unilateral TC.

RESULTS

The mean follow-up of all 2,124 patients was 14.9 years. Unilateral TC occurred in 2.028 patients (the mean age of 32.4 years), 707 of them had seminoma, 1.310 nonseminomatous (NS) TC and 11 spermatocytic tumours. The 1st tumour of metachronous bilateral disease was diagnosed at a significantly younger age (27.1 years) compared to the unilateral disease (32.4 years). The mean interval between the 1st and the 2nd TC was 8.2 years. Patients with NSTC had a longer mean interval (9.2 years) between the 1st and the 2nd TC in comparison with seminoma patients (6.7 years). The mean age at diagnosis for seminoma was significantly higher (31.3 years) compared to the NSTC (24.1 years). Bilateral seminoma occurred in 5 synchronous bilateral TC patients, four patients had discordant histology, none presented with bilateral NSTC.

CONCLUSIONS

Bilateral TC is a rare and requires individualized management of patients (Tab. 5, Fig. 4, Ref. 32).

Stage I testicular seminoma risk-adapted therapeutic management

Following orchiectomy, patients with clinical stage I (CSI) testicular seminoma may be managed by active surveillance (S) or adjuvant treatment (radiotherapy or chemotherapy). In view of the published data on long-term toxicity, especially second malignant neoplasms (SMNs), adjuvant radiotherapy (ART) is currently no longer recommended as an adjuvant therapy option for these patients. The purpose of our recent study was to compare the impact of two selected treatment approaches - S versus adjuvant chemotherapy (ACT) on the survival of patients with CSI testicular seminoma. This cross-sectional study analyzed a total of 139 patients collected at a single center between 10/2011-5/2020, with CSI testicular seminoma, stratified into two groups according to risk-adapted therapeutic approaches. In the S group (low-risk - without rete testis invasion - RTI, primary tumor size <4 cm), consisting of 77 patients, who underwent S, relapse occurred in 10 (13.0%) patients after a mean follow-up of 14.3 months. In the ACT group (high-risk - RTI and/or primary tumor size >4 cm), consisting of 62 patients, who were treated with ACT, relapse occurred in 5 (8.1%) patients after a mean follow-up of 11.6 months. Overall survival of patients in both groups was 100% with a mean follow-up of 43.9 months. A statistically significant difference in progression-free survival (PFS) between these two groups was not found. Based on our findings, ACT seems to be an adequate treatment for patients with a high risk of relapse, as well as S for those with a low risk of relapse. Despite its excellent prognosis, optimal management of CSI testicular seminoma remains controversial, with variations in expert opinion and international guidelines.

Extremely rare synchronous primary neoplasms in testicular cancer patients

OBJECTIVES

This study analyzes the incidence of multiple primary malignant neoplasms (MPN) in patients with testicular cancer (TC), the results are compared with literature findings and assess the rarest subgroup of patients with MPN.

PATIENTS AND METHODS

Clinical data of 1870 patients with TC treated or followed up in a single center in the period of 5/1970-12/2018 were collected and analyzed retrospectively in focus of the occurrence of MPN.

RESULTS

The overall incidence of MPN was 150 (8.02 %). There were 89 cases of bilateral TC (59.3 %), of these 8 cases were synchronous (diagnosed within three months period from the primary diagnosis) and 81 metachronous (9 % and 91 % respectively). Non-testicular other primary malignancies (OPM) occurred in 61 cases (40.7 %), of which 59 cases were metachronous (96.7 %) and two cases were synchronous (3.3 %). Metachronous malignancies included mainly prostate cancer (n = 17 patients), kidney cancer (n = 13 patients) and colorectal cancer (n = 12 patients). Synchronous OPM was found in two patients.

CONCLUSION

In our study we registered two cases of synchronous OPM, both histologically clear cell renal cancer. We have analyzed clinical characteristics, diagnosis and treatment strategies of synchronous OPM, in order to improve its diagnosis and therapy (Fig. 3, Ref. 22).

Results of long term testosterone replacement therapy in men with abdominal obesity, erectile dysfunction and testosterone deficiency

INTRODUCTION

In this article, the authors evaluate subjective and objective results of long testosterone replacement therapy (TRT) and possible risk.

METHODS

In a single center study, the authors treated 69 men with testosterone deficiency syndrome (TDS). The average age was 57.84 years and the follow-up period was 94.62 months. All men had at beginning a complete urological and internal examination. All the men were treated with three-month i.m. injections of 1000 mg testosterone undecanoate. The men were regularly checked according to the EAU guidelines.

RESULTS

All of the men on treatment felt much better. Weight and waist circumference during monitoring showed a mild improvement. Excellent results were on red blood cells. Glucose, HDL cholesterol, triglycerides had stable values. PSA slightly increased and testosterone was within the normal range. In two men during treatment, we found a prostate cancer (low risk). Bone mineral density (BMD) of lumbar spine revealed a significant improvement.

CONCLUSION

TRT had multiple positive effect on affected men with TDS. Our long-term results showed a long mild improvement during the time. Authors concluded that long term treatment had multiple benefit for affected men (Fig. 11, Ref. 13).

Late relapse in stage I of nonseminomatous germ cell testicular cancer on surveillance

OBJECTIVE

Primary aim was to assess relapse‑free survival (RFS) in patients with clinical stage I (CS I) of non-seminomatous germ cell testicular tumors (NSGCTT) undergoing surveillance after orchiectomy. The secondary aim was to examine differences in risk factors in patients with early relapse (ER 2 years) and very late relapse (VLR > 5 years).

METHODS

Cross-sectional study analyzed 25‑year single‑center experiences with 198 CS I NSGCTT patients according the time to relapse.

RESULTS

RFS was 160/198 (80.8 %). Relapse occurred in 38 (19.2 %) patients after a median fol-low-up of 7.57 months, 33 (86.8 %) patients had ER after a median follow-up of 7.03 months and 5 patients had LR (13.2 %) after a median follow-up of 26.28 months. One patient (2.63 %) had VLR after follow-up > 5 years (7.17 years). Three relapsed patients died with metastatic disease after a mean follow-up of 5.1 years from the date of diagnosis. Another three patients died without cancer after a mean follow-up of two years. OS was 192/198 (97 %).

CONCLUSION

Diagnosis and treatment of late relapsing NSGCTT patients should be performed in experienced centers only. Occurrence of LR is the reason for long-term monitoring of NSGCTT survivors (Tab. 1, Fig. 1, Ref. 14).

Recent Trends in Survival of Testicular Cancer Patients - Nation-wide Population Based Study

INTRODUCTION AND AIM

Survival of germ cell testicular cancer (TC) patients is better than for other malignancies and has not yet been exactly studied in the Slovak Republic. The aim of the study, based on the analyses of epidemiological data over time, was to present 5-year survival trends for germ cell TC patients.

PATIENTS AND METHODS

Survival is assessed within the framework of a nation-wide retroprospective study among TC patients newly diagnosed between 1993-2007 (divided to three 5-year periods according the time of diagnosis - 1993-1997, 1998-2002 and 2003-2007). Standardized 5-year survival rates were calculated and compared between the periods using a widely accepted methodology. TC patients were divided into two groups (seminomas and non-seminomas histopathologically) and to two groups according the age at diagnosis (< 40 vs. 40 years). The demographic characteristics of TC patients were analyzed using descriptive statistics. Statistical analysis was carried out using Microsoft Excel 2013, statistical software STATISTICA and Joinpoint Regression Programe, Version 4.3.1.0.

RESULTS

Five-year survival of TC patients (n = 2.748) diagnosed from 1993 to 2007 was 92.21%. TC patients diagnosed between 1993 and 1997 (n = 810) reached 5-year survival at 91.23%, between years 1998 and 2002 (n = 916) at 92.14% and between years 2003 and 2007 (n = 1.022) at 93.05%. There was not a statistically significant difference in survival among these three 5-year periods. Significant difference in 5-year survival was observed between seminomas and non-seminomas in each 5-year period. Compared with younger patients (age < 40 years), there was a significantly worse survival for TC patients (age 40 years) in all groups.

CONCLUSION

Moderate improvement in survival for TC patients in the Slovak Republic is probably influenced by diagnostic and therapeutic progress, including multidisciplinary care and patients concentration in specialized centers. The long-term follow-up of TC survivors can also help to prevent late side effects of the treatment modalities and to detect second malignancies.Key words: testicular cancer - seminoma - non-seminoma - age at diagnosis - survival.

Testosterone Deficiency and Bone Metabolism Damage in Testicular Cancer Survivors

The aim of the study was to investigate the influence of therapeutic modalities and sexual hormone levels on changes in bone mineral density (BMD) in testicular cancer (TC) survivors. In a cross-sectional descriptive, long-term follow-up study, a total of 1,249 long-term TC survivors were evaluated according to treatment modality: orchiectomy (OE) only, OE + chemotherapy (CT), or OE + radiotherapy (RT). Luteinizing hormone (LH), total testosterone (TST), marker of bone resorption (β-carboxyl-terminal cross-linking telopeptide of type I collagen-CTx), and BMD were evaluated. Standard statistical techniques were used to test the differences between groups of patients. TST decrease was observed in 46/313 TC survivors after OE alone, in 103/665 after OE + CT, and in 66/271 after OE + RT. LH increase was observed in 23/313 TC survivors after OE alone, in 154/665 after OE + CT, and in 43/271 after OE + RT. CTx increase was observed in 116/313 TC survivors after OE alone, in 324/665 after OE + CT, and in 82/271 after OE + RT. Osteopenia/osteoporosis occurred in 136/313 TC survivors after OE alone, in 298/665 after OE + CT, and in 139/271 after OE + RT. TC survivors after RT have statistically significant decreased TST levels, increased LH and nonsignificant worse BMD (osteopenia/osteoporosis) in comparison with TC survivors after OE alone or CT. TST decrease and LH increase were statistically significant, more frequently observed in patients with osteopenia/osteoporosis. Examination of TST is an important part of follow-up in TC survivors with bilateral as well as unilateral disease. The important part of standard examination algorithm should be also the osteological examination of TC survivors mainly in patients with androgen deficiency.

Importance of Different Grades of Abdominal Obesity on Testosterone Level, Erectile Dysfunction, and Clinical Coincidence

The aim of the current study was to investigate the influence of different grades of abdominal obesity (AO) on the prevalence of testosterone deficiency syndrome (TDS), erectile dysfunction (ED), and metabolic syndrome (MetS). In a cross-sectional descriptive study, a total of 216 males underwent a complete urological, internal, and hormonal evaluation. Males were divided according to waist circumference into five groups: less than 94 cm (Grade [G] 0), 94 to 101 cm (G1), 102 to 109 cm (G2), 110 to 119 cm (G3), and more than 120 cm (G4). Incidence of ED, TDS, and MetS was compared in these groups and in participants without AO. Some degree of ED was identified in 74.7% of males with AO. In G1, there were 61% of males with ED, in G2 68%, in G3 83%, and in G4 87%. A strong correlation between testosterone (TST) level and AO was identified. Ninety-eight out of 198 (49.5%) males with AO and 1/18 (5.5%) males without AO had TDS. There were significant differences between individual groups. In the group of males with AO G4 (more than 120 cm), 87.1% had TDS. MetS was diagnosed in 105/198 (53.0%) males with AO, but in G4, 83.9% of males with AO had MetS. Males older than 40 years of age with AO have a higher incidence of ED, TDS, and MetS. Dividing males into five groups according to waist circumference seems to be reasonable. With growing AO, there were significantly more males with ED, TDS, and MetS.

Controversies in the management of clinical stage I testicular seminoma

Introduction

Following orchiectomy patients with clinical stage I (CSI) testicular seminoma may be managed by active surveillance (AS) or adjuvant treatment (radiotherapy or chemotherapy). In view of the published data on long-term toxicity, mainly second malignant neoplasms (SMNs), adjuvant radiotherapy (ART) is currently no longer recommended as adjuvant therapy for these patients. The purpose of our recent study was to compare the impact of two selected treatment approaches – AS versus adjuvant chemotherapy (ACT) on survival in patients with CSI testicular seminoma.

Material and methods

The cross-sectional study analyzed a total of 106 patients collected at a single centre between 4/2008–8/2015, with CSI testicular seminoma, stratified into two groups according to risk-adapted therapeutic approaches.

Results

In group A (low-risk), consisting of 84 patients, who underwent AS, relapse occurred in 10 (11.9%) patients after a mean follow-up of 13.8 months. In group B (high-risk), consisting of 22 patients, who were treated with ACT, relapse occurred in two (9.1%) patients after a mean follow-up of 13.8 months. Overall survival of patients in both groups was 100% with a mean follow-up of 25.3 months. The statistically significant difference in progression-free survival (PFS) between these two groups was not found.

Conclusions

ACT seems to be adequate treatment for patients with high-risk of relapse, as well as AS for those with low-risk of relapse. Despite its excellent prognosis, optimal management of CSI testicular seminoma remains controversial, with variations in expert opinion and international guidelines.

Malignant Mesothelioma of the Tunica Vaginalis Testis. A Clinicopathologic Analysis of Two Cases with a Review of the Literature

Paratesticular malignant mesothelioma is an extremely rare type of mesothelioma with only a limited number of reported cases. Its clinical differentiation is challenging, and its diagnosis is almost exclusively accidental. The major risk factor is exposure to asbestos, typically with a long latency between exposure and diagnosis. The current study presents the clinical data of two patients diagnosed with paratesticular malignant mesothelioma. We evaluated a large spectrum of risk factors in the patients histories. The histomorphological and immunohistochemical characteristics were analysed and put into the perspective of a broad differential diagnosis. Both cases of malignant epithelial mesothelioma of the tunica vaginalis testis clinically presented as unilateral hydroceles. Patients underwent surgery with the perioperative finding of a tumour. Radical inguinal orchiectomy was the treatment of choice for both patients. After comprehensive staging, the second patient underwent a second step of inguinal and pelvic lymph node dis- section. Follow-up visits revealed recurrence of the disease in the first patient. Resection of the tumour was performed. The histology confirmed the relapse of a tumour with identical features to those of the first tumour. Chemotherapy and radiotherapy were not indicated. Both patients are currently in complete remission. In conclusion, surgical treatment had a determinative role in the prognosis of these patients. Radical orchiectomy is the treatment of choice for localized disease. Lymph node dissection can be considered in the case of lymph node enlargement. There is a lack of evidence-based data for adjuvant chemotherapy and radiotherapy. Patients should be referred to experienced multidisciplinary cancer centres for a second opinion on histology, treatment, and a follow-up plan.Key words: mesothelioma - tunica vaginalis testis - hydrocele - asbestos exposure.

Controversies in the management of clinical stage I nonseminomatous germ cell testicular cancer

Surveillance after orchiectomy alone has become popular in the management of clinical stage I of nonseminomatous germ cell testicular tumors (CSI NSGCTT). Efforts to identify patients at high-risk of relapse led to a search for risk factors in CSI NSGCTT. The aim of the current study was to analyze longterm experiences with risk-adapted therapeutic approaches (active surveillance and adjuvant chemotherapy). From 1/ 1992 to 2/ 2015, a total of 454 CSI NSGCTT patients were included in the study and stratified into two groups according to risk-adapted therapeutic approaches. In Group A (low- risk CSI NSGCTT), which consisted of 287 patients who underwent surveillance, relapse occurred in 48 (16.7%) patients with a median followup of 7.0 months. Six patients (2.1%) of this group died with a median followup of 34.3 months. In Group B (high-risk CSI NSGCTT), which consisted of 167 patients who were treated with adjuvant chemotherapy, relapse occurred in two (1.2%) patients with a median followup of 56.2 months. One patient (0.6%) died 139.4 months following orchiectomy. Statistically significant difference in progression free survival between these two groups was found, but no significant difference in overall survival.Key words: testicular cancer -  surveillance -  adjuvant chemotherapy -  disease progression.

Current possibilities of cervical precancerous lesions screening in Slovakia: prevalence of high risk human papillomavirus in patients with cytological diagnoses of atypical squamous cells of unknown significance

INTRODUCTION

It has been confirmed, that there is a causal relationship between persistent infection of high risk human papillomavirus (HR-HPV) and the development of cervical cancer. In population of women older than 30 years HPV infection becomes a significant etiological factor of precancerous lesion of the cervix, but HPV infection may spontaneously regress in the majority of the cases.

PATIENTS AND METHODS

The analysed study group consisted of 397 samples with cytological diagnosis of atypical squamous cells of unknown significance (ASCUS). All cases underwent HPV DNA testing using the Hybrid Capture 2 (HC2) assay. We analysed prevalence of HR-HPV and a viral load expressed as relative light units/cut off ratio (RLU/CO) in different age groups with cytological diagnoses of ASCUS.

RESULTS

The prevalence of HR-HPV with cytological diagnoses of ASCUS was detected in 44 %. The prevalence of HR-HPV between patients aged 17-29 and between patients aged 30-40 was 55 % and 48 % respectively and we detected significant reduction of prevalence (28 %) in patients older than 41 years.

CONCLUSION

Based on the results of presented study we assumed that age the 40 and over is crucial for the development of serious precancerous lesions in Slovakia, thus this age group is the most suitable for HPV triage of ASCUS. As a refinement of that type of ASCUS triage we recommend to add to the algorithm quantitative measurement of viral load in the specimens in the form of RLU/CO ratio (Fig. 3, Ref. 27).

Management of patients with clinical stage I nonseminomatous germ cell testicular cancer: Active surveillance versus adjuvant chemotherapy - single-centre experience

Surveillance after orchiectomy alone has become popular in the management of clinical stage I nonseminomatous germ cell testicular tumors (CSI NSGCTT). Efforts to identify patients at high risk of disease progression led to a search for risk factors in CSI NSGCTT. The aim of the present study was to analyse single-centre experience with risk-adapted therapeutic approaches (active surveillance versus adjuvant chemotherapy). From 1/1992 to 12/2013 a total of 431 CSI NSGCTT patients were included in the study and stratified into two groups according to risk-adapted therapeutic approaches. Group A (low-risk CSI NSGCTT) consisted of 276 patients who underwent active surveillance, progression of disease occurred in 46 (16.7%) patients with a median follow-up of 7.2 months. Six patients (2.2 %) of this group died with a median follow-up of 34.3 months. Group B (high-risk CSI NSGCTT) consisted of 155 patients who were treated with adjuvant chemotherapy, disease progression occurred in two (1.3 %) of them with a median follow-up of 56.2 months. One patient (0.6 %) died 139.4 months following orchiectomy. Overall survival rate of all CSI NSGCTT patients in both groups was 424/431 (98.4 %) with median follow-up of 130.4 months following orchiectomy. Surveillance policy is recommended only in patients with low-risk CSI NSGCTT.

KEYWORDS

testicular cancer, surveillance, adjuvant chemotherapy, disease progression.

Changing patterns in thyroid cancer incidence and mortality in the Slovak Republic by histological type and age

BACKGROUND

Thyroid cancer (TC) is the most common malignant disease of the endocrine system; however, in the Slovak Republic (SR), time trends of incidence and mortality according to histological type and age of patients have never been reported.

MATERIALS AND METHODS

Long-term (1968-2007) trends from the National Cancer Registry data of overall, histology and age-specific incidence and mortality in the SR have been calculated using join-point regression and other descriptive characteristics.

RESULTS

Age-standardized overall incidence rates increased significantly in females by an estimated annual percentage change (APC) of 3.6 %, and in males by 2.2 %. Overall mortality decreased by APC -2.1 % in females and -0.9 % in males. The mean ages of female and male TC patients at the time of diagnosis significantly decreased; ages at the time of death significantly increased. The incidence of papillary carcinoma rose significantly in females by 8.9 %, compared with 6.1 % in males; follicular carcinoma in males and females was stable. Medullary carcinoma was stable in females; in males, it rose by 5.2 %. Poorly differentiated TC was stable in females; undifferentiated/anaplastic carcinomas decreased in both sexes.

CONCLUSIONS

The incidence of TC, especially of selected histological types, is dramatically rising in the SR in both genders, while mortality is decreasing. Patients diagnosed in recent years are younger and died at a greater age than those reported in older national data. These trends seem to be affected by more intensive diagnosis in the most recent years.

Trends and estimates in prostate cancer incidence, mortality and prevalence in the Slovak Republic, 1968-2012

Prostate cancer is the third most-common non-skin cancer and also the third leading cause of cancer death in the Slovak Republic in recent years. However, analysis of incidence and mortality long-term time-trends, on the basis of which the prevalence estimates could have been calculated, were not available. This paper analyses national trends in prostate cancer incidence and mortality from 1968 to 2007 by using the join-point regression to propose potential changes in health care. The authors noted a statistically significant increase in the values of incidence after 1999 and improvement in mortality after 1998. Using a mathematical modelation authors predicted the overall prostate cancer prevalence in the Slovak Republic to provide actual data for health management.

Recent patterns in testicular cancer incidence, mortality and survival in the Slovak Republic with reference to international comparisons

Incidence of testicular cancer in the Slovak Republic (SR) sharply increased in 1968-2006 (annual change 0.195/100,000, 95% CI = -0.178-0.212, p < .0001). Mortality was stabilized in 1968-2006 (-0.005/100,000/year, 95% CI = -0.011-0.001, p = .148), however, from 1990, it had a mildly significant decreasing trend. The 5-year relative survival for patients from the cohort 1993-1997 reached 91.7% (95% CI = 87.5-94.7), for the cohort 1998-2002, it was 93.2% (95% CI = 89.5-95.8). The average age of patients with seminomas was 30-41 years (25-75% quantile), for nonseminomas 23-34 years (25-75% quantile).

Long-term trends in the development of the epidemiology of breast cancer in the Slovak and Czech Republic with reference to applied screening and international comparisons

Breast cancer represents a major problem in oncology and epidemiology, especially because of the growing trends in its incidence, which are most pronounced in countries with historically low levels of incidence of this disease and because of the increasingly unfavorable mortality trends even in some countries where screening has been established. The purpose of this study is to analyse the incidence of breast cancer and resulting mortality in two neighbouring countries with national population-based cancer data in central Europe and to assess possible reasons for any differences discovered. The recorded increase in the incidence of breast cancer in the Slovak and Czech Republic is apparently the result of a westernizing lifestyle. In the Czech Republic the acceleration of the incidence of this disease recorded after 1991 was more pronounced than in the Slovak Republic, which may be influenced especially by the more pronounced increase in the number of mammograms but also by a higher prevalence of risk factors of the disease. After the year 1991 a stabilization of mortality was recorded in both countries. However, this stabilization is not satisfactory but is correlated with the unsatisfactory extent (in the case of the Slovak Republic still unorganized) of screening, with the low number (or unused) mammograms, with slow onset of anti-cancer therapy and with expenditures for health care below the European average. The existing situation with an unfavourable mortality trend in all age groups indicates the importance of implementing intervention measures.

Paratesticular mesothelioma in young age. Case report

BACKGROUND

Malignant mesothelioma is a neoplasm arising in serosal membranes in the body cavities. Usual presentation of the tumor is in the pleura, peritoneum and less frequently pericardium. Paratesticular mesothelioma is the rarest known form of malignant mesothelioma with only a limited number of reported cases.

CASE

A case of malignant epithelial mesothelioma of the tunica vaginalis testis was reported with presentation of hydrocele and multinodular intrascrotal masses in a 20-year old male. The patient underwent surgery for post-traumatic long-term hydrocele with perioperative discovery of multiple small exophytic structures. After histological findings of the malignant mesothelioma of tunica vaginalis testis, he underwent left-side orchiectomy, followed by inguinal and pelvic lymph node dissection. Clinical staging did not reveal distant metastases. Regular follow-up visits based on physical examinations and imaging studies are to date negative for recurrence.

CONCLUSION

Literature data were reviewed, and possible risk factors for the development of the neoplasm were analysed.

Do we know the cause of the highest colorectal cancer incidence, the changes in the mortality trends and the clinical stages in the Slovak and Czech Republic, the representatives of the Central European region?

Slovak (SR) and Czech (CR) Republics reach up the highest recorded incidence rates of colorectal cancer. In analysis of the development and changes in colorectal cancer incidence in the above-mentioned countries, it was reported the most considerable incidence increase of the disease in males in the SR, then in males in the CR, subsequently in females in the SR and the slowest incidence rate was reported in females in the CR. Colorectal cancer mortality increased most rapidly in males in the SR, then in males in the CR, slower increase was reported in females in the SR and in females in the CR the mortality was in the long term stabilized. In both countries and both sexes clinical stage II is noted most frequently, also the decrease of the disease number in the clinical stage I and in undefined stage, and a slight decrease in other clinical stages. The trends in risk factors of colorectal cancer in the SR and CR would support the hypotheses of the later culmination of incidence and on the higher levels than in other developed countries. The purpose of this study is to analyse the character and changes in development of incidence, mortality and clinical stages of colorectal cancer (1980-2005) and to assess the influence of selected risk factors on the highest disease incidence in above-mentioned two Central European countries.

Trends in the kidney cancer incidence and mortality in the Slovak and Czech Republics in 1980-2005 - in the context of an international comparison

Incidence rates of kidney cancer vary in global standards more than tenfold, the highest worldwide rates are repeatedly registered in the Czech Republic (hereafter CR) and in other geographically neighbouring countries in Central Europe, including the Slovak Republic (hereafter SR). The aim of the study was to analyse the changes in time trends of incidence and mortality from kidney cancer in two geographically close countries (CR and SR) and to compare detected differences with the worldwide data. In spite of high rates of incidence and its global growth in analyses in 1980 - 2005, the character of its progress in time was changed in both countries. While in 1980 - 1994 the incidence of kidney cancer in males and females in both analysed countries increased significantly, after 1994 (to 2005) stagnation in males in SR and significant slowdown of its growth in males in CR were reported. In females in SR after 1994 significant slowdown of the incidence growth was reported and in CR there was even its non-significant fall. Mortality trend in both sexes in both countries in 1980-2005 was slower than the incidence. After 1994 (to 2005) in males in SR statistically non-significant slowdown of mortality growth was reported, in CR it was statistically significant fall of mortality rates. In women after 1994 (to 2005) statistically non-significant decrease was reported, in CR the decrease was significant. The increase of total incidence of the disease is not explained only by the growth of asymptomatic localized tumors due to high quality diagnostic methods, but it likely reflects actual growth of new cases of the disease. Assumed partial cause of the mortality stabilization and slowdown of the incidence growth after its previous culmination in 1994 is the decline of smoking and obesity prevalence in the last decades in men, although this fact does not reflect situation in women. More striking mortality decrease in CR in comparison with SR might be influenced by potentially more radical surgical therapy (rate of the amount of surgery within primary therapy according to the data in National Cancer Registry CR raises, in SR the data are not available) and by more significant increase of the disease rate in the clinical stages I and II in CR (in SR only short-time data are available).

Trends in prostate cancer incidence and mortality before and after the introduction of PSA testing in the Slovak and Czech Republics

AIMS AND BACKGROUND

As two neighboring countries in central Europe with national cancer registries, the Slovak (SR) and Czech Republics (CR) are countries with a medium global rate in the occurrence of prostate cancer. This paper analyzes the incidence of prostate cancer and mortality before and after the introduction of PSA testing in the two Republics and the possible reasons for any differences discovered and compares the results with selected regions and countries of the world.

STUDY DESIGN AND RESULTS

In the Slovak Republic, prostate cancer incidence (age-adjusted to the world standard population) has risen from 14.6/100,000 in 1968 (95% CI, ±1.5772) to 36.2/100,000 in 2005 (95% CI, ±2.0678). The estimated annual increase in the incidence during the period 1968-1991 (before nationwide PSA testing) was 0.421; from 1991 (when nationwide PSA testing began) to up to 2003 it was 0.941. Mortality rates grew from 7.3/100,000 in 1968 to 14.9/100,000 in 2005. In spite of the geographic proximity of the two countries, the increase in incidence occurred faster in the Czech than in the Slovak Republic, from 15.8/100,000 in 1977 (95% CI, ±0.9748) to 59.5/100,000 in 2005 (95% CI, ±1.7187). The estimated annual increase in incidence in the Czech Republic for the period of 1977-1991 was 0.581. From 1991 (when national PSA testing began) until 2003, it was 1.981. In the period before 1991, mortality rose more sharply in the Czech than in the Slovak Republic, whereas after the introduction of PSA testing mortality stabilized more quickly in the Czech than in the Slovak Republic. In the Slovak Republic, a significant reduction in mortality was observed after 2002 and has continued to the present and probably is not affected only by the results connected with the increase in PSA testing.

CONCLUSIONS

The difference in the incidence and mortality of prostate cancer in the Slovak and the Czech Republics results from a difference in the intensity of PSA testing as well as from the introduction of complex, more effective treatment in advanced clinical stages.

Trends in Prostate Cancer Incidence and Mortality before and after the Introduction of PSA Testing in the Slovak and Czech Republics

Aims and background

As two neighboring countries in central Europe with national cancer registries, the Slovak (SR) and Czech Republics (CR) are countries with a medium global rate in the occurrence of prostate cancer. This paper analyzes the incidence of prostate cancer and mortality before and after the introduction of PSA testing in the two Republics and the possible reasons for any differences discovered and compares the results with selected regions and countries of the world.

Study design and results

In the Slovak Republic, prostate cancer incidence (age-adjusted to the world standard population) has risen from 14.6/100, 000 in 1968 (95% CI, ±1.5772) to 36.2/100, 000 in 2005 (95% CI, ±2.0678). The estimated annual increase in the incidence during the period 1968–1991 (before nationwide PSA testing) was 0.421; from 1991 (when nationwide PSA testing began) to up to 2003 it was 0.941. Mortality rates grew from 7.3/100, 000 in 1968 to 14.9/100, 000 in 2005. In spite of the geographic proximity of the two countries, the increase in incidence occurred faster in the Czech than in the Slovak Republic, from 15.8/100, 000 in 1977 (95% CI, ±0.9748) to 59.5/100, 000 in 2005 (95% CI, ±1.7187). The estimated annual increase in incidence in the Czech Republic for the period of 1977–1991 was 0.581. From 1991 (when national PSA testing began) until 2003, it was 1.981. In the period before 1991, mortality rose more sharply in the Czech than in the Slovak Republic, whereas after the introduction of PSA testing mortality stabilized more quickly in the Czech than in the Slovak Republic. In the Slovak Republic, a significant reduction in mortality was observed after 2002 and has continued to the present and probably is not affected only by the results connected with the increase in PSA testing.

Conclusions

The difference in the incidence and mortality of prostate cancer in the Slovak and the Czech Republics results from a difference in the intensity of PSA testing as well as from the introduction of complex, more effective treatment in advanced clinical stages.

Prostate cancer incidence and mortality in selected countries of Central Europe

BACKGROUNDS

This paper analyzes the incidence and mortality of prostate cancer in the Slovak (SR) and Czech (CR) Republics (as Central European countries with population-based cancer registries) before and after the introduction of PSA testing, the possible reasons for any differences disclosed, and compares the results with selected regions and countries around the world.

MATERIAL, METHODS AND RESULTS

In SR, the age-adjusted incidence of prostate cancer rose from 14.6/100,000 in 1968 to 36.2/100,000 in 2005. The estimated annual increase of incidence from 1968 to 1991 (before nation-wide PSA testing) was 0.421 and 1991-2003 it reached 0.941. The mortality rates rose from 7.3/100,000 in 1968 to 14.9/100,000 in 2005. The increase in incidence occurred faster in CR than in SR, from 15.8/100,000 in 1977 to 59.5/100,000 in 2005. The estimated annual increase of incidence in CR in 1977-1991 was 0.581,while in 1991-2003 it reached 1.981. Before 1991, mortality rose more sharply in CR than in SR while after the introduction of PSA testing mortality stabilized more quickly in the CR than in SR. In SR a significant reduction of mortality was observed after 2002 and is probably affected by more factors than those associated with the increase in PSA testing.

CONCLUSION

The difference in the incidence and mortality of prostate cancer in SR and in CR results from a difference in the intensity of PSA testing as well as from the earlier introduction of effective treatment in CR.

Recent patterns in stomach cancer descriptive epidemiology in the Slovak Republic with reference to international comparisons

BACKGROUNDS

Even though the incidence and mortality from stomach cancer declined dramatically, it remains the third most frequent cancer worldwide. This study analysed the incidence and resulting mortality, and possible reasons for any differences identified between the Slovak Republic and other countries.

MATERIAL AND METHODS

Analysis of national data covering the period from 1968 to 2006. Trends have been estimated using linear regression model and are presented with corresponding 95% Confidence Intervals (CI) and p-values with null hypothesis being constant in time.

RESULTS

In 2006, standardized incidence index for stomach cancer in Slovak males (related to 1968) declined by 0.28, annual percentage change was -3.2% and the average decrease of standardized incidence represented -0.956/100,000 (95% CI -1.059 to -0.853, p <0.0001). The incidence in men had statistically significantly more rapidly declining tendency in the first half of the analyzed period (1968-1986). Decrease in the mortality index was 0.32 with annual percentage change of -2.9% and the mean decrease in standardized mortality of -0.691/100,000 (95% CI -0.750 to -0.632, p < 0.0001). In 2006, the standardized incidence index for stomach cancer in Slovak females (related to 1968) declined by 0.23, annual percentage change was -3.7% and the mean decrease in standardized incidence was -0.491/100,000 (95% CI -0.554 to -0.428, p < 0.0001), the decline in incidence was more pronounced in the first half of the analyzed period. The mortality index (1968-2006) declined by 0.26, annual percentage change was -3.4% and annual decrement of standardized mortality represented -0.367/100,000 (95% CI -0.407 to -0.326, p < 0.0001). Only a non-significant change was identified for the proportions of the individual stomach cancer clinical stages with high proportion of clinical stages III and IV in both sexes.

CONCLUSION

Decline in the incidence and mortality appears to be decelerating, intervention in primary prevention is essential.

Damage of hormonal function and bone metabolism in long-term survivors of testicular cancer

Improved survival of testicular cancer (TC) patients leads to rising of interest on the disease consequences for the whole organism (impact on hormonal status, bone metabolism). The aim of the study was to present three years experience with hormonal and osteologic examination in long-term survivors of TC. During the period of 11/2005-1/2009 879 patients who were previously treated for TC (823 with unilateral, 56 with bilateral disease) were examined. Each patient underwent hormonal and osteologic examination, results of which were associated with therapy following orchiectomy and with the time interval since the primary therapy. The median follow-up time in patients with unilateral TC was 96 months since the therapy. Mean age at the time of examination was 32 years. Testosterone deficiency was observed in 171 patients (19.5%), increased LH in 168 patients (19.1%), increased S-CTx in 388 patients (44.1%). Bone damage (osteopenia and/or osteoporosis) was observed in 445 patients (50.6%). The median follow-up time in patients with bilateral TC was 175 months. Mean age at the time of examination was 27 years. Testosterone deficiency was observed in 47 patients (83.9%), increased LH in 45 patients (80.4%), increased S-CTx in 31 patients (55.4%). Bone damage was observed in 41 patients (73.2%). Hormonal examination and testosterone substitution may be recommended as an important aspect of patient s follow-up in bilateral TC, moreover in unilateral disease. The important part of standard examination algorithm should be also osteological examination to prevent osteopenia or even osteoporosis development.

Prostate cancer treatment in Europe at the end of 1990s

BACKGROUND

There is wide variation in prostate cancer incidence and survival across Europe. In many countries incidence is rising sharply in relation to the introduction of prostate-specific antigen assay, and there is concern that patients may not be treated appropriately. We therefore aimed to characterize treatment for prostate cancer across Europe.

METHODS

We performed a high resolution population-based study, collecting information on the treatment of 3 486 prostate cancer cases diagnosed in 1995-1999 in 11 cancer registries from six European countries.

RESULTS

Overall, about one in three patients received radical treatment (prostatectomy 23% or radiotherapy 14%); about 60% of younger patients (<70 years) received radical treatment, while a similar proportion of older patients (> or =70 years) received palliation (transurethral prostatectomy or hormone treatment only). A considerable proportion (61%) of patients with apparently high-risk disease were treated radically within a year of diagnosis, with large variation between regions: >70% in Calvados, Haut-Rhin, Tarn and Eindhoven and <50% in Slovakia and Cracow. Overall 34% of patients with apparently low-risk disease received radical treatment, varying from 17% and 22% in Bas-Rhin and Granada, to 52% and 56% in Calvados and Eindhoven.

CONCLUSIONS

Our data indicate wide variation in the treatment for prostate cancer even among patients with apparently similar disease, and further suggest a non-negligible proportion may be receiving inappropriate radical treatment for apparently low-risk disease. Current guidelines indicate active surveillance should become the main means of managing low-risk disease.

Human exposure to polyhalogenated hydrocarbons and incidence of selected malignancies -central European experience

This paper describes results of two ecological studies design to analyze the incidence of selected malignancies in two populations exposed to polychlorinated hydrocarbons, mostly PCBs and TCDDs/Fs by comparing data available in the National Cancer Registry of the Slovak Republic and National Oncological Registry of the Czech Republic databases for the Slovak Republic (approximately 5M inhabitants) and the Czech Republic (10,3 M inhabitants) to the data relevant for the population of Michalovce District, the Slovak Republic (approximately 112,000 inhabitants) and Uherske Hradiste, the Czech Republic (146,000 inhabitants). Those districts are recognized as PCB-contaminated areas due to production and industrial use of PCBs. Data were analyzed for the 10-year period 1987-1996. The age adjusted world standard ratio (WSR) incidence of thyroid, pancreatic, breast, ovarian, bladder, and brain tumors in females and thyroid, pancreatic, breast, bladder, brain, prostate and testicular tumors in males were compared. Neither PCBs nor TCDDs/Fs appear to contribute to the observed significantly lower incidence of breast and prostate cancer in the Michalovce District and lower bladder cancer incidence in Uherske Hradiste District. However, anti-estrogenic and anti-androgenic properties have been described for hydroxylated and methylsulfonyl PCB metabolites. These properties could contribute to a mechanism through which these metabolites might modulate the development of breast, prostate and bladder cancer. The results of our analysis points to substantial potential problems of risk assessment for cancer incidence in populations exposed to xenobiotics, or more generally, as it relates to a wide spectrum of confoundings of cancer risk factors.

Epidemiological features of testicular cancer in the Slovak Republic--retrospective study

BACKGROUND

Testicular cancer (TC) is quite a rare malignancy, however, its medical importance has risen due to the rapid growth in incidence in the last three decades. Age-adjusted mortality rates have fallen within the space of 20 years.

PATIENTS AND METHODS

A national retrospective descriptive study evaluated the data of 1,805 patients with 1,832 TC diagnosed in Slovakia from 1993 to 2002. Patients and medical questionnaires, case histories, clinical symptoms and objective parameters in all cases of TC were analyzed.

RESULTS

The average age-adjusted incidence (to the world-standard population) (1993-2002) was 6.2/100,000; mortality 0.5/100,000 of males. When comparing the risk factors between the group of patients with bilateral and unilateral TC, the most frequent risk factor was inguinal hernia (8.6%, p = 0.0026). 3% of patients developed a bilateral TC. Metachronous tumors were found in 70.4% of patients with bilateralTC. The average age at diagnosis of the first tumor in patients with bilateral TC was 27.5 years (p = 0.001); most of them (55%) were diagnosed between the age of 20-29 years. The average age of patients with unilateral TC was 34 years. 8 patients presented with a synchronous bilateral tumor, 47 patients had a second tumor diagnosed 2-302 months after primary orchiectomy. In the case of seminomas, the time interval between the first and second tumor was 85 months, while for nonseminomatous tumors, the same interval was 72 months (a statistically insignificant difference).The median follow-up time of patients with TC was 112.5 months (range of 7-342 months), five-year survival was 96.2%.

CONCLUSION

Further studies of the epidemiologic characteristics of TC are inevitable in order to define the risk factors of the disease and the possibilities of timely therapeutical intervention.

Human lung cancer and hexavalent chromium exposure

OBJECTIVE

Workers chronically exposed to hexavalent chromium have higher incidence of lung cancer. Our study investigates incidence of lung cancer types, age at onset of the disease and survival time among chromium exposed workers (smelters, tapers, crane operators) in comparison to non-exposed persons.

METHODS

64 chromium exposed workers and 104 male controls with diagnosed lung cancer were analysed. The average exposure time among workers was 16.71 +/- 10.02 (S.D.) years (range 1- 41 years).

RESULTS

Chromium exposure significantly decreases the age at the onset of the disease by 3.51 years (62.20 +/- 9.08 years in exposed group and 65.71 +/- 10.50 years in control; P=0.018). Small cell lung carcinoma (SCLC) forms 25.0 % of all cases in chromium exposed workers and 16.34% in non exposed individuals. No correlation was found between the age at the diseases onset and time of exposure. The mean survival time in exposed group was 9.03 +/- 12.73 month, in control 12.14 +/- 21.94 month, but this difference was not significant (P=0.473).

CONCLUSION

Occupational exposure to chromium was identified as an important risk factor of lung cancer, decreasing the age at the diseases onset. Higher percentage of SCLC was found in chromium exposed individuals.

National portal of cancer epidemiology in the Slovak Republic

The directive of the Ministry of Health, called "The obligatory report on malignant tumors", specify the conditions of collecting and processing data about the patients with tumors. This material is presented in the Bulletin of the Ministry of Health 2000, part 10-12, Act No. 576/2004 of the Statute Book, and amended by the Amendment No. 662/2007 of the Statute Book. National Cancer Registry of the Slovak Republic, National Health Information Centre, would like to answer many requests for an easy and comprehensible access to the national data on cancer epidemiology. The working group created a new analytic web-page, called "National portal on cancer epidemiology". All data are valid, adapted for publications and quotation and the access to the web-page is free for the wide professional public (Ref. 5).

Dominant position of colorectal cancer in Slovakia: the old-new problem for cancer control

The development of colorectal cancer in former Czechoslovakia and its successor states is illustrated using recorded mortality and from 1968 incidence rates retrieved from National Cancer Registry of Slovakia. The relatively high mortality rates in Czechoslovakia around 1950 contrasted with rates seen in other countries of central, southern and particularly of eastern Europe and were more close to those recorded in affluent countries of western Europe and northern America. Despite continuous stabilisation and decrease of this cancer in high risk countries from late 1970s the unexpected and gradual rise of incidence rates of colorectal cancer was recorded in Slovakia. During the period studied incidence rates rose by an annual mean percent change of 4,2 and 2,8 in colon and 2,2 and 1,0 in rectal cancer in males and females respectively. Beginning with the year 1995 colorectal cancer is the most common cancer in this country in both genders together. Study of the development of colorectal cancer at the levels of subsites indicated the higher rates but decreasing proportion of rectal cancer and increasing proportion of cases occurring in proximal colon. The importance of this new priority in diagnostics, treatment and control programmes is stressed.

Epidemiology and treatment delay in testicular cancer patients: a retrospective study

INTRODUCTION

Testicular cancer (TC) is a quite rare malignancy, although its medical importance is growing due to a rapid growth in incidence. The recent age-adjusted incidence in the Slovak Republic attained 6.9/100,000; mortality was 0.4/100,000. Incidence has increased by 80% in the period 1968-2003. Diagnostic and treatment delay may have an impact on overall survival.

MATERIALS AND METHODS

A national descriptive study evaluating the data of patients with TC diagnosed in Slovakia in the period 1993-2002 was designed. Patients were analyzed using medical questionnaires, case histories, clinical symptoms, parameters such as data of treatment onset and treatment approaches, histology of the tumor, the stage of disease, response to treatment, and the follow-up period in all 1,832 cases of TC.

RESULTS

The average incidence (1993-2002) was 6.2/100,000; mortality was 0.5/100,000. The median follow-up time of the patients with TC was 112.5 months, overall survival was 91% and 5-year survival was 96.2%. Mortality decrease and survival improvement, despite the incidence increase, are the result of not only an effective treatment, but also early diagnosis of each case. The overall treatment delay (mean time of 150 days) shows that young males are generally poorly informed about the possibility of TC occurrence.

CONCLUSION

The only methods to decrease the mortality of patients with TC, can be early detection and risk-adapted treatment in specialized centers according to the histology and clinical stage using standardized guidelines and long-term follow-up of patients with this malignancy.

Nonseminomatous germ cell testicular tumors clinical stage I: differentiated therapeutic approach in comparison with therapeutic approach using surveillance strategy only

Surveillance after orchiectomy alone becomes popular for the management of clinical stage I nonseminomatous germ cell testicular tumors (CS I NSGCTT). Effort to identify patients at high risk of relapse leads to searching for risk factors of CS I NSGCTT. The aim of the study was to analyse own long-term experiences with different therapeutic approaches in CS I NSGCTT patients according to risk factors of the disease progression and to correlate these results with the group of patients who were treated with surveillance strategy only. From 11/1984 to 12/1991 a total of 145 patients with CS I NSGCTT were treated with surveillance strategy only (group A) and were followed-up to 1/2007. Patients, who had the disease progression, were treated with systemic chemotherapy. The disease progression was experienced in 52 patients (35.9 %). The overall survival rate of the patients in this group was 130/145 (89.7 %). From 1/1992 to 1/2007 a total of 323 patients with CS I NSGCTT were stratified to different risk-adapted therapeutic approaches (groups B1-3) according to histopathologic findings of primary tumor removed by inguinal orchiectomy. 111 patients (group B1) with vascular invasion and majority of embryonal carcinoma component in the primary tumor were treated with adjuvant chemotherapy (2 cycles of BEP). Disease progression developed in two patients (1.9 %). Other patients live without evidence of disease (NED). None of them died. Among 11 patients (group B2) with vascular invasion and majority with teratomatous elements in the primary tumor underwent primary retroperitoneal lymph node dissection (RPLND), 9 were found to be pathological stage I. The disease progression was observed in two patients (18.2 %), they died 87-122 months following orchiectomy. Two patients (18.2 %) with pathological stage II received adjuvant chemotherapy. Other 7 patients live with NED following RPLND. 201 patients (group B3) without vascular invasion have been followed after orchiectomy alone. They were kept under close surveillance, consisting of regular follow-up with tumor markers, chest x-ray and CT of the retroperitoneum. The disease progression was observed in 39 patients (19.4 %), who were treated with BEP chemotherapy. Three of them (7.7 %) died after a mean follow-up of 32.7 months following orchiectomy. The overall survival rate of all patients in group B1-3 was 98.4 %. Introduction of different therapeutic approaches in CS I NSGCTT patients according to risk factors of the disease progression might reduce the overall relapse rate of these patients from 35.9 % (group A) to 19.4 % (group B3) (P< 0.001). Surveillance procedure is recommended only in patients without vascular invasion in the primary tumor.