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Tariqi R, El Aboudi A, Boughaleb A, Boualaoui I, Ibrahimi A, El Sayegh H, Nouini Y. Giant testicular mixed germ cell tumour in an elderly patient: A case report. Urol Case Rep 2024; 55:102760. [PMID: 38841430 PMCID: PMC11152899 DOI: 10.1016/j.eucr.2024.102760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/14/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024] Open
Abstract
Although germ cell tumours can appear in childhood, they are most common around the age of 30. These tumours are highly responsive to chemotherapy, and even cases of relapse have relatively high cure rates. There is limited literature on patients diagnosed after the age of 50, and no specific trials have been carried out in this context. These patients, considered 'elderly', are treated with the same cisplatin-containing combinations as younger patients, despite the higher toxicity. This report presents an observation of a giant testicular mixed germ cell tumour discovered in a 75-year-old patient.
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Affiliation(s)
- Reda Tariqi
- Department of Urologic Surgery "A" Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
- Mohammed V University, Rabat, Morocco
| | - Adam El Aboudi
- Department of Urologic Surgery "A" Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
- Mohammed V University, Rabat, Morocco
| | - Abdelmounim Boughaleb
- Department of Urologic Surgery "A" Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
- Mohammed V University, Rabat, Morocco
| | - Imad Boualaoui
- Department of Urologic Surgery "A" Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
- Mohammed V University, Rabat, Morocco
| | - Ahmed Ibrahimi
- Department of Urologic Surgery "A" Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
- Mohammed V University, Rabat, Morocco
| | - Hachem El Sayegh
- Department of Urologic Surgery "A" Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
- Mohammed V University, Rabat, Morocco
| | - Yassine Nouini
- Department of Urologic Surgery "A" Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
- Mohammed V University, Rabat, Morocco
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Wu X, Zhou M, Lyu J, Chen L. Competing risk nomogram predicting cause-specific mortality in older patients with testicular germ cell tumors. Front Med (Lausanne) 2024; 11:1327485. [PMID: 38695022 PMCID: PMC11061386 DOI: 10.3389/fmed.2024.1327485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/20/2024] [Indexed: 05/04/2024] Open
Abstract
Background Testicular germ cell tumor (TGCT) is the most common type of malignancy in young men, but rarely in older adults. We aimed to construct a competing risk model to predict the prognosis for older patients with TGCT. Methods We collected TGCT patients aged 50 years or older diagnosed between 2004 and 2015 from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database. We estimated the cumulative incidences of cause-specific death (CSD) and other causes of death and established a nomogram predicting cause-specific mortality in older patients with TGCT by Fine-Gray competing risk regression. The concordance index (C-index), calibration curves, area under the receiver operating characteristic curve (AUC), and decision analysis curves (DCA) were used to evaluate the differentiation, accuracy, and clinical significance of the nomogram. Results A total of 2,751 older TGCT patients were included in the study. The 3-, 5-, and 10-year cumulative incidences were 4.4, 5.0 and 6.1%, respectively, for cause-specific death, and 3.8, 6.2, 13.1%, respectively, for other causes of death. Predictors of cause-specific mortality in older TGCT included age, marital status, annual household income, histology, tumor size, stage and surgery. In the training and validation sets, the C-indexes were greater than 0.8, indicating that the nomogram had good discrimination. The AUC revealed the same result. The calibration curves showed good agreement between the predicted and observed results of the nomogram. DCA curves indicated that the nomogram had more clinical significance than the conventional American Joint Committee on Cancer (AJCC) staging. Based on the total nomogram score of each case, all patients were categorized into low-risk and high-risk groups, and risk categorization allowed the identification of cases with a high risk of death. Conclusion We established a competing risk nomogram with good performance that may help clinicians accurately predict the prognosis of older TGCT patients.
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Affiliation(s)
- Xiaoying Wu
- College of Pharmacy, Jinan University, Guangzhou, China
| | - Mingfei Zhou
- Drug Clinical Trial Institution, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lin Chen
- Drug Clinical Trial Institution, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Pastorino U, Leuzzi G, Sabia F, Girotti P, Duranti L, Radaelli S, Fiore M, Stacchiotti S, Patrizia G, Salvioni R, Gronchi A. Long term outcome of complex surgical resection and reconstruction for rare thoracic cancers. TUMORI JOURNAL 2023; 109:450-457. [PMID: 36797831 PMCID: PMC10540492 DOI: 10.1177/03008916231154763] [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: 10/21/2022] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Complex surgical resection and reconstruction for rare thoracic cancers (RTCs) represent a major challenge, given their very low frequency, extreme variability of presentation, multi-modality treatment options and inadequate outcome prediction. We analysed the experience of a tertiary referral centre on a consecutive series of patients with thoracic germ cell tumours, thymomas and sarcomas, with the aim of reporting the long-term outcome by cancer type and complexity of surgical procedures. METHODS From Jan 2003 to Dec 2018, 768 surgical procedures were performed with curative intent on 644 RTC patients. Study endpoints were: post-operative hospital stay (Pod), 30-day and 90-day mortality, 5-year and 10-year overall survival (OS). Median follow-up of alive patients was 7.2 years. RESULTS Median Pod was 7 days, with a 1.2% 30-day and 2.9% 90-day mortality. OS was 90.8% at one year, 74.2% at five years and 62.8% at 10 years. Ten-year OS was 73.0% in low, 65.3% in intermediate, and 55.6% in high complexity score (Log-rank tests p<0.0001); 66.6% in patients with one or two reconstructions and 46.4% in patients with three or more reconstructions (p<0.0001); 46.0% with vascular and 50.0% with chest wall reconstruction; 71.8% in germ cell tumours, 64.6% in thymoma and 51.3% in sarcoma (p<0.0001). CONCLUSION Complex surgical resection and reconstruction was associated with acceptable 90-day mortality and good 10-year survival in all RTC types. A predictive score based on surgical complexity and cancer type can help the clinical decision making.
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Affiliation(s)
- Ugo Pastorino
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Leuzzi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Sabia
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Girotti
- Department of General and Thoracic Surgery, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Leonardo Duranti
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Radaelli
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Stacchiotti
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giannatempo Patrizia
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Salvioni
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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4
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Almutairi F, Geisler D, Rammal R, Korentzelos D, Bastacky S, Dhir R, Bhattu A, Quiroga-Garza GM. Malignant germ cell tumors in men aged 50 years and over are associated with adverse pathologic features and higher stage at presentation. Ann Diagn Pathol 2023; 62:152070. [PMID: 36495736 DOI: 10.1016/j.anndiagpath.2022.152070] [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: 09/14/2022] [Revised: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Germ cell tumors (GCT) are the most common malignancy in men in the third and fourth decades of life. The occurrence of malignant GCT in men aged 50 years or over is rare, and their histopathologic characteristics and outcome is insufficiently characterized in the medical literature. Hence, we report the histopathologic features and clinical outcome of malignant GCTs in men aged ≥50 years at our institution. DESIGN We performed a retrospective search of our database from 2005 to 2021 to identify men aged 50 years or older with malignant GCT. Cases of spermatocytic tumor were excluded. Clinical and histopathologic features of the tumors were reviewed. RESULTS Forty-seven cases were identified, showing a sharp decline in incidence over the age of 65. Thirty-nine (83 %) tumors were testicular while eight (17 %) were non-testicular in presentation. Cases included 26 (55 %) seminomas, 15 (32 %) non-seminoma/mixed malignant GCT, and 5 (11 %) regressed testicular germ cell tumors. The most common component in mixed malignant GCTs was embryonal carcinoma (77 %), followed by seminoma and yolk sac tumor (62 % each). Germ cell neoplasia in situ (GCNIS) accompanied 57 % of the cases. Aggressive pathologic features, including lymphovascular invasion, retroperitoneal/lymph node involvement and higher stage at presentation, were identified in a significant proportion of cases (36/47, 77 %). Clinical follow up showed six patients (14 %) died of disease-related causes. CONCLUSION Our findings expand and corroborate the previously reported data on malignant GCT in older men. Unique characteristics include tendency for higher stage at presentation with adverse pathologic features and more aggressive clinical course.
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Affiliation(s)
- Fawaz Almutairi
- Department of Pathology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States of America; Department of Pathology, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Daniel Geisler
- Department of Pathology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States of America
| | - Rayan Rammal
- Department of Pathology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States of America
| | - Dimitrios Korentzelos
- Department of Pathology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States of America
| | - Sheldon Bastacky
- Department of Pathology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States of America
| | - Rajiv Dhir
- Department of Pathology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States of America
| | - Amit Bhattu
- Department of Urology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States of America
| | - Gabriela M Quiroga-Garza
- Department of Pathology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States of America
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Sharma A, Morrison L, Milic M, Ghose A, Gogbashian A, Vasdev N, Agarwal S, Pullar B, Rustin G. A North-West London Experience of the Impact of Treatment Related Toxicity on Clinical Outcomes of Elderly Patients with Germ Cell Tumors. Cancers (Basel) 2022; 14:cancers14204977. [PMID: 36291757 PMCID: PMC9599778 DOI: 10.3390/cancers14204977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/19/2022] [Accepted: 10/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background/Aim: The occurrence of germ cell tumour (GCT) in the elderly is rare, with scarce data available. The aim of this study was to understand the clinical outcomes of patients with GCT in patients aged > 45 years. Materials and Methods: A retrospective study was conducted in a large tertiary cancer centre in north-west London. Between 1 January 2003 and 31 March 2022, 108 cases of GCT in men aged > 45 years were identified and treated at the Mount Vernon Cancer Centre. The median age at diagnosis was 54 years (range = 45−70 years). Results: The 5-year survival rate of all patients was 96%, and the toxicity profile was similar to the younger age group. Conclusion: Older patients with GCT are able to tolerate chemotherapy; however, care must be taken to prevent life-threatening complications using appropriate dose modification.
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Affiliation(s)
- Anand Sharma
- Department of Medical Oncology, Mount Vernon Cancer Centre, London HA6 2RN, UK
- Correspondence:
| | - Laura Morrison
- Department of Medical Oncology, Mount Vernon Cancer Centre, London HA6 2RN, UK
| | - Marina Milic
- Department of Medical Oncology, Mount Vernon Cancer Centre, London HA6 2RN, UK
| | - Aruni Ghose
- Department of Medical Oncology, Mount Vernon Cancer Centre, London HA6 2RN, UK
| | - Andrew Gogbashian
- Department of Radiology, Mount Vernon Cancer Centre, Paul Strickland Scanner Centre, London HA6 2RN, UK
| | - Nikhil Vasdev
- Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, East and North Herts NHS Trust, Stevenage SG1 4AB, UK
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9EU, UK
| | - Samita Agarwal
- Department of Histopathology, Lister Hospital, East and North Herts NHS Trust, Stevenage SG1 4AB, UK
| | - Ben Pullar
- Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, East and North Herts NHS Trust, Stevenage SG1 4AB, UK
| | - Gordon Rustin
- Department of Medical Oncology, Mount Vernon Cancer Centre, London HA6 2RN, UK
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Secondino S, Rosti G, Tralongo AC, Nolè F, Alaimo D, Carminati O, Naspro RLJ, Pedrazzoli P. Testicular tumors in the “elderly” population. Front Oncol 2022; 12:972151. [PMID: 36185182 PMCID: PMC9523537 DOI: 10.3389/fonc.2022.972151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Germ cell tumors arise in childhood but peak at around 30 years of age. They are the most common cancers in males under the age of 35. Over 95% arise in the testes while a minority originate in extragonadal sites such as the anterior mediastinum, or mainly in childhood the pineal gland or the sacrococcygeal area. These tumors show an extraordinary sensitivity to chemotherapy (and for seminoma, also to radiation) and cure rates are relatively high even in second or subsequent relapses. Very few data are present in the literature regarding patients diagnosed after 50 years and no specific trials have been conducted in this setting. Nearly all patients reported in the literature had testicular cancers, with occasional reports of extragonadal tumors. Despite the fact that > 50 years may be considered an “elderly” population, these patients are treated with the same cisplatin containing combinations as their younger counterparts with consequent higher toxicity. In this review we will present epidemiological and clinical data from this rare population of patients with testicular cancer.
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Affiliation(s)
- Simona Secondino
- Department of Oncology and Hematology, Medical Oncology Unit, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Giovanni Rosti
- Department of Oncology and Hematology, Medical Oncology Unit, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
- *Correspondence: Giovanni Rosti,
| | - Antonino C. Tralongo
- Medical Oncology Unit Umberto I Hospital, Rete Assistenza Oncologica (RAO) Department of Oncology, Azienda Sanitaria Provinciale (ASP), Siracusa, Italy
| | - Franco Nolè
- Medical Oncology Division of Urogenital and Head & Neck Tumours, European Institute of Oncology Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Domiziana Alaimo
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Ornella Carminati
- Medical Oncology, Ospedale per gli Infermi, AUSL Romagna, Rimini, Italy
| | | | - Paolo Pedrazzoli
- Department of Oncology and Hematology, Medical Oncology Unit, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
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7
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Hapakova N, Chovanec M, Rejlekova K, Kalavska K, Obertova J, Palacka P, De Angelis V, Svetlovska D, Sycova‑Mila Z, Mardiak J, Mego M. Effects of primary granulocyte‑colony stimulating factor prophylaxis on the incidence of febrile neutropenia in patients with germ cell tumors. Oncol Lett 2022; 24:308. [PMID: 35949605 PMCID: PMC9353223 DOI: 10.3892/ol.2022.13428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/30/2022] [Indexed: 11/23/2022] Open
Abstract
Testicular germ cell tumors (GCTs) are the most common solid malignancy in males aged 15–35 years. Febrile neutropenia (FN) is a serious complication of chemotherapy that frequently occurs in patients with GCTs. The present retrospective study aimed to evaluate the effect of primary granulocyte-colony stimulating factor (G-CSF) prophylaxis on the incidence of FN in patients with GCTs. The present study included a review of the medical records of patients diagnosed with GCTs treated with first-line/adjuvant chemotherapy between January 2000 and December 2017 at the National Cancer Institute (Bratislava, Slovakia). In January 2006, a decision was made to administer G-CSF prophylaxis (filgrastim or pegfilgrastim) to patients after every cycle of chemotherapy. The present study included 385 patients, and out of these, 264 patients received primary G-CSF prophylaxis, while 121 patients did not. A total of 71 patients (18.4%) suffered from FN events. In the subgroup that did not receive primary prophylaxis, 42 patients exhibited FN, while only 29 patients with primary prophylaxis suffered from FN (34.7 vs. 11.0%; P=0.00000003). According to the subgroup analysis, FN incidence was decreased in all groups that received primary prophylaxis, except for patients with stage I GCT receiving adjuvant chemotherapy, without affecting overall survival. Primary G-CSF prophylaxis was associated with markedly reduced FN incidence in patients treated with first-line chemotherapy for metastatic disease. Therefore, the results of the present study suggested that primary G-CSF prophylaxis should be considered in patients with GCT receiving first-line chemotherapy.
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Affiliation(s)
- Nikola Hapakova
- Second Department of Oncology, Comenius University, Faculty of Medicine, National Cancer Institute, 833 10 Bratislava, Slovak Republic
| | - Michal Chovanec
- Second Department of Oncology, Comenius University, Faculty of Medicine, National Cancer Institute, 833 10 Bratislava, Slovak Republic
| | - Katarina Rejlekova
- Second Department of Oncology, Comenius University, Faculty of Medicine, National Cancer Institute, 833 10 Bratislava, Slovak Republic
| | - Katarina Kalavska
- Second Department of Oncology, Comenius University, Faculty of Medicine, National Cancer Institute, 833 10 Bratislava, Slovak Republic
| | - Jana Obertova
- Second Department of Oncology, Comenius University, Faculty of Medicine, National Cancer Institute, 833 10 Bratislava, Slovak Republic
| | - Patrik Palacka
- Second Department of Oncology, Comenius University, Faculty of Medicine, National Cancer Institute, 833 10 Bratislava, Slovak Republic
| | - Valentina De Angelis
- Second Department of Oncology, Comenius University, Faculty of Medicine, National Cancer Institute, 833 10 Bratislava, Slovak Republic
| | - Daniela Svetlovska
- Second Department of Oncology, Comenius University, Faculty of Medicine, National Cancer Institute, 833 10 Bratislava, Slovak Republic
| | - Zuzana Sycova‑Mila
- Second Department of Oncology, Comenius University, Faculty of Medicine, National Cancer Institute, 833 10 Bratislava, Slovak Republic
| | - Jozef Mardiak
- Second Department of Oncology, Comenius University, Faculty of Medicine, National Cancer Institute, 833 10 Bratislava, Slovak Republic
| | - Michal Mego
- Second Department of Oncology, Comenius University, Faculty of Medicine, National Cancer Institute, 833 10 Bratislava, Slovak Republic
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Guida E, Tassinari V, Colopi A, Todaro F, Cesarini V, Jannini B, Pellegrini M, Botti F, Rossi G, Rossi P, Jannini EA, Dolci S. Mapk activation drives male and female mouse teratocarcinomas from late PGCs. J Cell Sci 2022; 135:274751. [PMID: 35297490 DOI: 10.1242/jcs.259375] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/09/2022] [Indexed: 11/20/2022] Open
Abstract
Germ cell tumors (GCTs) are rare tumors that can develop in both sexes, peaking in adolescents. To understand the mechanisms that underlie germ cell transformation, we established a GCT mouse model carrying germ cell-specific BRafV600E mutation with or without heterozygous Pten deletion. Both male and female mice developed monolateral teratocarcinomas containing embryonal carcinoma (EC) cells that showed an aggressive phenotype and metastatic ability. Germ cell transformation started in fetal gonads and progressed after birth leading to gonadal invasion. Early postnatal testes showed foci of tumor transformation, while ovaries showed increased number of follicles, multi-ovular follicles (MOFs) and scattered metaphase I oocytes containing follicles. Our results indicate that Mapk over-activation in fetal germ cells of both sexes can expand their proliferative window leading to neoplastic transformation and metastatic behavior.
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Affiliation(s)
- Eugenia Guida
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Valentina Tassinari
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ambra Colopi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Federica Todaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Valeriana Cesarini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Benedetto Jannini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Manuela Pellegrini
- Institute of Biochemistry and Cell Biology, IBBC-CNR, Monterotondo, Rome, Italy
| | - Flavia Botti
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.,Pathology Department, S. Eugenio Hospital, Rome, Italy
| | - Gabriele Rossi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Pellegrino Rossi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Susanna Dolci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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9
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King J, Adra N. Current Status of Stem Cell Transplant in Treatment of Testicular Germ Cell Tumors. Curr Oncol Rep 2022; 24:303-310. [PMID: 35113353 DOI: 10.1007/s11912-022-01204-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW We aim to discuss the history of high-dose chemotherapy with autologous stem-cell transplant in testicular germ cell tumors, prognostic factors to consider prior to transplant, and issues both during and after transplant while also touching on the use of conventional-dose vs. high-dose chemotherapy for initial salvage treatment in patients with relapsed disease. RECENT FINDINGS The advancements in the treatment of testicular cancer have led to the majority of patients even with distant metastases being cured of their malignancy. Despite this, around 20% of patients with metastatic disease will relapse after first-line therapy, and the majority of these patients will go on to need further salvage chemotherapy, either with conventional-dose chemotherapy or high-dose chemotherapy. High-dose chemotherapy with autologous stem-cell transplant is an effective salvage therapy and will still remarkably result in cures for the majority of patients with relapsed disease. While patients receiving it as even third-line salvage therapy may achieve cures, earlier administration likely results in greater efficacy.
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Affiliation(s)
- Jennifer King
- Division of Hematology & Medical Oncology - Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, 535 Barnhill Dr, RT 459, Indianapolis, IN, 46202, USA
| | - Nabil Adra
- Division of Hematology & Medical Oncology - Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, 535 Barnhill Dr, RT 459, Indianapolis, IN, 46202, USA.
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10
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Caso R, Jones GD, Bains MS, Hsu M, Tan KS, Feldman DR, Funt SA, Reuter VE, Bosl GJ, McHugh D, Huang J, Molena D, Amar D, Fischer G, Rusch VW, Jones DR. Outcomes After Multidisciplinary Management of Primary Mediastinal Germ Cell Tumors. Ann Surg 2021; 274:e1099-e1107. [PMID: 31977510 PMCID: PMC7371518 DOI: 10.1097/sla.0000000000003754] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We examined management strategies, overall survival (OS), and progression-free survival (PFS) among patients with PMNSGCTs undergoing resection and multidisciplinary management at a high-volume institution. SUMMARY OF BACKGROUND DATA Outcomes after resection of PMNSGCTs are not well-characterized, with limited data on factors associated with survival. METHODS We reviewed patients with PMNSGCT who underwent resection between 1980 and 2019. Median follow-up was 3.4 years. Preoperative therapy (including use of bleomycin), surgical management, recurrence, and survival were examined. Factors associated with survival were analyzed using Cox regression. RESULTS In total, 113 patients were included [median age, 28 years (range, 16-65)]. Preoperative serum tumor markers (STMs) normalized/decreased in 74% of patients. Pathology included necrosis only (25%), teratoma +/- necrosis (20%), viable nonteratomatous germ cell tumor +/- teratoma (41%), and secondary somatic-type malignancy +/- teratoma (20%). Bleomycin chemotherapy was not associated with pulmonary complications or 90-day mortality. Patients receiving second-line chemotherapy followed by resection had significantly worse OS and PFS than patients receiving first-line chemotherapy followed by resection. On multivariable analysis, R1/R2 resection (HR, 3.92; P < 0.001) and increasing postoperative STMs (HR, 4.98; P < 0.001) were associated with shorter PFS; necrosis on pathology (HR, 0.42, P = 0.043) was associated with longer PFS. CONCLUSIONS In patients with PMNSGCT undergoing resection, completeness of resection, postoperative pathology, and postoperative STMs were associated with PFS. Induction bleomycin was not associated with pulmonary complications or mortality in patients undergoing resection. Patients undergoing second-line chemotherapy followed by resection have a poor prognosis, with long-term survival of 22%.
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Affiliation(s)
- Raul Caso
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gregory D. Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Manjit S. Bains
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Meier Hsu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Darren R. Feldman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samuel A. Funt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Victor E. Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - George J. Bosl
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Deaglan McHugh
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniela Molena
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Amar
- Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gregory Fischer
- Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Valerie W. Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David R. Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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11
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Agrawal V, Abonour R, Abu Zaid M, Althouse SK, Ashkar R, Albany C, Hanna NH, Einhorn LH, Adra N. Survival outcomes and toxicity in patients 40 years old or older with relapsed metastatic germ cell tumors treated with high-dose chemotherapy and peripheral blood stem cell transplantation. Cancer 2021; 127:3751-3760. [PMID: 34260067 DOI: 10.1002/cncr.33771] [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: 02/10/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND High-dose chemotherapy (HDCT) plus peripheral blood stem cell transplantation (PBSCT) is effective salvage therapy for relapsed metastatic germ cell tumors (GCTs) but has potential toxicity. Historically, an age of ≥40 years has been associated with greater toxicity and worse outcomes. METHODS This is a retrospective analysis of 445 consecutive patients with relapsed GCT treated with HDCT and PBSCT with tandem cycles at Indiana University from between 2004-2017 per our institutional regimen. Kaplan-Meier methods and log-rank tests were used for progression-free survival (PFS) and overall survival (OS) analysis. RESULTS A total of 329 patients were <40 years of age, whereas 116 patients were ≥40 years of age; HDCT was used as second-line therapy in 85% and 79%, respectively. Median follow-up time was 42.5 months (range, 0.3-173.4 months). Grade ≥3 toxicities were similar between either group, except for greater pulmonary (P = .02) and renal toxicity (P = .01) in the ≥40-years-of-age group. Treatment-related mortality was similar between both age groups: 10 patients (3%) in the <40-years-of-age group and 4 patients (3.5%) in ≥40-years-of-age group died from complications of HDCT. Two-year PFS for <40 years of age versus ≥40 years of age was 58.7% versus 59.6% (P = .76) and 2-year OS was 63.9% versus 61.5% (P = .93). Factors predicting worse PFS included Eastern Cooperative Oncology Group performance status ≥1, platinum refractory disease, nonseminoma histology, and not completing 2 cycles of HDCT. Age was not an independent predictor of worse outcomes. CONCLUSIONS HDCT plus PBSCT is effective salvage therapy in patients ≥40 years of age with relapsed metastatic GCT. Patients ≥40 years of age experience similar rates of toxicity and treatment-related mortality as those <40 years of age.
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Affiliation(s)
- Vaibhav Agrawal
- Division of Hematology-Oncology, Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana
| | - Rafat Abonour
- Division of Hematology-Oncology, Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana
| | - Mohammad Abu Zaid
- Division of Hematology-Oncology, Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana
| | - Sandra K Althouse
- Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana
| | - Ryan Ashkar
- Division of Hematology-Oncology, Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana
| | - Costantine Albany
- Division of Hematology-Oncology, Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana
| | - Nasser H Hanna
- Division of Hematology-Oncology, Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana
| | - Lawrence H Einhorn
- Division of Hematology-Oncology, Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana
| | - Nabil Adra
- Division of Hematology-Oncology, Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana
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12
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Collins K, Alkashash AM, Hwang M, Kaimakliotis HZ, Cheng L, Idrees MT. Somatic-Type Yolk Sac Tumor Arising as a Predominant Component of Bladder Urothelial Carcinoma. Int J Surg Pathol 2021; 30:207-213. [PMID: 34255554 DOI: 10.1177/10668969211030688] [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: 11/15/2022]
Abstract
Germ cell differentiation has been described in association with somatic tumors arising from several organ systems; rare cases arising from urothelium have been reported. Here we present a 62-year-old male with a remote history of lung cancer, a left adrenal gland mass, and a 5.6 cm left bladder wall mass; cystoscopy demonstrated a large papillary mass on the left anterior bladder wall. A transurethral resection specimen was sent for review in consultation and showed extensive papillary structures with thin fibrovascular cores lined by neoplastic cells with clear cytoplasm. These neoplastic cells were diffusely positive for pancytokeratin, CDX2 (caudal-type homebox 2), SALL4 (sal-like transcription factor 4), glypican-3, AFP (alpha-fetoprotein), while negative for PAX-8 (paired box gene 8), NKX3.1 (NK3 homeobox 1), PSA (prostate specific antigen), TTF-1 (thyroid transcription factor 1), Napsin A, inhibin, and OCT4 (octamer-binding transcription factor 4). Conventional urothelial conventional carcinoma and focal squamous differentiation were also identified as minor components. Urothelial carcinoma was focally positive for GATA3 (GATA-binding protein 3) and p63; SALL4 and glypican-3 were negative. Overall findings supported a yolk sac tumor with a smaller component of squamous cell carcinoma (<1%). Subsequent cystectomy showed similar morphologic features and immunoprofile in addition to foci of urothelial carcinoma and urothelial carcinoma in situ. No chromosome 12p abnormalities were identified by fluorescent in-situ hybridization study. A diagnosis of yolk sac tumor derived from urothelial carcinoma was made. Yolk sac tumor should be considered in the differential diagnosis of a high-grade urothelial carcinoma, particularly when glandular or other unusual architectural patterns are present. A somatic origin with underlying genomic instability similar to what has been described in the uterus and ovaries is suggested.
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Affiliation(s)
- Katrina Collins
- 12250Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ahmad M Alkashash
- 12250Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael Hwang
- 12250Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hristos Z Kaimakliotis
- 12250Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Liang Cheng
- 12250Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Muhammad T Idrees
- 12250Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
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13
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Funt SA, McHugh DJ, Tsai S, Knezevic A, O'Donnell D, Patil S, Silber D, Bromberg M, Carousso M, Reuter VE, Carver BS, Sheinfeld J, Motzer RJ, Bajorin DF, Bosl GJ, Feldman DR. Four Cycles of Etoposide plus Cisplatin for Patients with Good-Risk Advanced Germ Cell Tumors. Oncologist 2021; 26:483-491. [PMID: 33586274 PMCID: PMC8176973 DOI: 10.1002/onco.13719] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/05/2021] [Indexed: 01/08/2023] Open
Abstract
Background The National Comprehensive Cancer Network recommends either three cycles of bleomycin, etoposide, and cisplatin or four cycles of etoposide and cisplatin (EPx4) as initial chemotherapy for the treatment of good‐risk germ cell tumors (GCTs). To assess the response, toxicity, and survival outcomes of EPx4, we analyzed our experience. Material and Methods Response and survival outcomes, selected toxicities, and adherence to chemotherapy dose and schedule were assessed in patients with good‐risk GCT who received EPx4 at Memorial Sloan Kettering Cancer Center between 1982 and 2016. The results were compared with our past results and published data. Results Between 1982 and 2016, 944 patients with GCT were treated with EPx4, 289 who were previously reported plus 655 treated between January 2000 and August 2016. A favorable response was achieved in 928 of 944 patients (98.3%). Five‐year progression‐free, disease‐specific, and overall survival rates were 93.9%, 98.6%, and 97.9%, respectively. Median follow‐up was 7.3 years (range, 2.8 months to 35.5 years). Viable, nonteratomatous malignant GCT was present in 3.5% of 432 postchemotherapy retroperitoneal lymph node dissection specimens from patients with nonseminomatous GCT. Febrile neutropenia and thromboembolic events occurred in 16.0% and 8.9%, respectively, with one treatment‐related death. In the more recent 655‐patient cohort, full‐dose EPx4 was administered to 631 (96.3%), with deviations from planned treatment driven mainly by vascular (n = 13), hematologic (n = 11), renal (n = 7), or infectious (n = 5) events. Conclusion EPx4 is highly effective and well tolerated in patients with good‐risk GCTs and remains a standard of care. Implications for Practice Four cycles of etoposide and cisplatin (EPx4) is a standard‐of‐care regimen for all patients with good‐risk germ cell tumors with a favorable response rate and disease‐specific survival of 98%. Full‐dose administration of etoposide and cisplatin and complete resection of residual disease lead to optimal outcomes. EPx4 should be the recommended regimen in active smokers, patients with reduced or borderline kidney function, and patients aged 50 years or older, which are patient groups at increased risk for bleomycin pulmonary toxicity. Because of a risk of acquired severe pulmonary illness, EPx4 may also be favored for patients who vape or use e‐cigarettes and during ongoing transmission of severe acute respiratory syndrome coronavirus 2. The NCCN recommends either three cycles of bleomycin, etoposide, and cisplatin (BEPx3) or four cycles of etoposide and cisplatin (EPx4) as initial chemotherapy for the treatment of good‐risk germ cell tumors. This article assesses outcomes specific to EPx4 treatment.
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Affiliation(s)
- Samuel A Funt
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Deaglan J McHugh
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Stephanie Tsai
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Andrea Knezevic
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Devon O'Donnell
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Sujata Patil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Deborah Silber
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Maria Bromberg
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Maryann Carousso
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Brett S Carver
- Department of Urology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Joel Sheinfeld
- Department of Urology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Robert J Motzer
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Dean F Bajorin
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - George J Bosl
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Darren R Feldman
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
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14
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Kojo K, Kawai K, Kawahara T, Kimura T, Kandori S, Nagumo Y, Nitta S, Kojima T, Okuyama A, Higashi T, Nishiyama H. Recent malignant testicular tumor trend in Japan, a country with an aging population: a large-scale study of 2012-2015 hospital-based cancer registry data. Jpn J Clin Oncol 2020; 50:1201-1208. [PMID: 32627833 DOI: 10.1093/jjco/hyaa110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/05/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Japan's national database of hospital-based cancer registries is estimated to cover ~67% of all new cancer cases. Using this database, we analyzed the characteristics of the recently diagnosed testicular malignancy. METHODS We obtained data for 6510 adult testicular malignancy patients diagnosed in 2012-2015. The distributions of patient ages, histological diagnoses and testicular germ cell tumor hospital care volumes were determined. RESULTS The most common histology was seminoma (60.3% of all testicular malignancies), followed by non-seminoma (24.1%) and diffuse large B-cell lymphoma (13.1%). The median and mean ages of the testicular germ cell tumor patients were high at 38 and 39.8 years, respectively. The age distribution peaked at 30-40 years, followed by 40-50 years. Approximately 18% of testicular germ cell tumor patients were ≥50 years. The ages of the diffuse large B-cell lymphoma patients peaked at 70-80 years (mean 67.7 years). When the analysis was limited to the testicular germ cell tumor patients who received first-course cancer treatment at the participating hospitals, the number of high-volume hospitals with ≥20 testicular germ cell tumor care volume was limited to 61 (10.0% of the 605 hospitals that treated ≥1 testicular germ cell tumor patient). However, when the patients who changed hospitals during treatment or relapsed after treatment completion were analyzed together, the number of high-volume hospitals increased to 104 (17.0% of 612 hospitals). CONCLUSION The testicular germ cell tumor patients' mean age was nearly 40 years. The proportions of older testicular germ cell tumor patients and diffuse large B-cell lymphoma patients were higher than previously thought. The reasons for this trend are unknown, but it is important to address the trend identified herein in a country with a super-aging population.
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Affiliation(s)
- Kosuke Kojo
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Koji Kawai
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of Urology, International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Takashi Kawahara
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomokazu Kimura
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shuya Kandori
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshiyuki Nagumo
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Satoshi Nitta
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takahiro Kojima
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ayako Okuyama
- Center for Cancer Control and Information Services, National Cancer Center Japan, Tokyo, Japan
| | - Takahiro Higashi
- Center for Cancer Control and Information Services, National Cancer Center Japan, Tokyo, Japan
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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15
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The individualized significance of lymphadenectomy across all age groups and histologies in malignant ovarian germ cell tumors. Arch Gynecol Obstet 2020; 302:1441-1450. [PMID: 32888090 DOI: 10.1007/s00404-020-05772-3] [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: 12/28/2019] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the therapeutic role of lymphadenectomy on patients with malignant ovarian germ cell tumor (MOGCT) and to investigate the risk factors of lymph node metastasis. METHODS Patients of MOGCT between 1988 and 2013 with definite lymph node information were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Survival curves were estimated using the Kaplan-Meier method, and Cox regression analyses were performed to evaluate the effects of clinical and pathologic variables on survival. RESULTS 2424 MOGCT patients with information on lymph nodes were included. Of the entire cohort, 46.2% patients received lymphadenectomy. The most common (42.2%) histologic type was teratoma, and 70.6% patients had FIGO stage I disease. Cox proportional model verified that age, grade, and log odds of positive lymph nodes (LODDS) were independent prognostic factors. Subgroup analysis showed that the association between the lymph node resection and better survival in the different age cohort. CONCLUSIONS Lymphadenectomy is not recommended for children (0-14 years). For patients 40 years of age and older, and for those who have the dysgerminoma type or endodermal sinus type, lymphadenectomy had an outstanding therapeutic role. As a parameter to assess lymph node status, LODDS could be used to classify MOGCTs.
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16
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Honecker F, Aparicio J, Berney D, Beyer J, Bokemeyer C, Cathomas R, Clarke N, Cohn-Cedermark G, Daugaard G, Dieckmann KP, Fizazi K, Fosså S, Germa-Lluch JR, Giannatempo P, Gietema JA, Gillessen S, Haugnes HS, Heidenreich A, Hemminki K, Huddart R, Jewett MAS, Joly F, Lauritsen J, Lorch A, Necchi A, Nicolai N, Oing C, Oldenburg J, Ondruš D, Papachristofilou A, Powles T, Sohaib A, Ståhl O, Tandstad T, Toner G, Horwich A. ESMO Consensus Conference on testicular germ cell cancer: diagnosis, treatment and follow-up. Ann Oncol 2019; 29:1658-1686. [PMID: 30113631 DOI: 10.1093/annonc/mdy217] [Citation(s) in RCA: 198] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The European Society for Medical Oncology (ESMO) consensus conference on testicular cancer was held on 3-5 November 2016 in Paris, France. The conference included a multidisciplinary panel of 36 leading experts in the diagnosis and treatment of testicular cancer (34 panel members attended the conference; an additional two panel members [CB and K-PD] participated in all preparatory work and subsequent manuscript development). The aim of the conference was to develop detailed recommendations on topics relating to testicular cancer that are not covered in detail in the current ESMO Clinical Practice Guidelines (CPGs) and where the available level of evidence is insufficient. The main topics identified for discussion related to: (1) diagnostic work-up and patient assessment; (2) stage I disease; (3) stage II-III disease; (4) post-chemotherapy surgery, salvage chemotherapy, salvage and desperation surgery and special topics; and (5) survivorship and follow-up schemes. The experts addressed questions relating to one of the five topics within five working groups. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel. A consensus vote was obtained following whole-panel discussions, and the consensus recommendations were then further developed in post-meeting discussions in written form. This manuscript presents the results of the expert panel discussions, including the consensus recommendations and a summary of evidence supporting each recommendation. All participants approved the final manuscript.
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Affiliation(s)
- F Honecker
- Tumor and Breast Center ZeTuP, St. Gallen, Switzerland; Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany.
| | - J Aparicio
- Department of Medical Oncology, Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | - D Berney
- Department of Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - J Beyer
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany
| | - R Cathomas
- Department of Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - N Clarke
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - G Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - K-P Dieckmann
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany
| | - K Fizazi
- Department of Cancer Medicine, Gustave Roussy, University of Paris Sud, Villejuif, France
| | - S Fosså
- Department of Oncology, Oslo University Hospital Radiumhospitalet, Oslo, Norway
| | - J R Germa-Lluch
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), Barcelona University, Barcelona, Spain
| | - P Giannatempo
- Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - J A Gietema
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - S Gillessen
- Department of Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen; University of Bern, Bern, Switzerland
| | - H S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine, UIT - The Arctic University, Tromsø, Norway
| | - A Heidenreich
- Department of Urology, Uro-Oncology, Robot-assisted and Specialised Urologic Surgery, University of Cologne, Cologne, Germany
| | - K Hemminki
- Department of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - R Huddart
- Department of Radiotherapy and Imaging, The Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
| | - M A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - F Joly
- Department of Urology-Gynaecology, Centre Francois Baclesse, Caen, France
| | - J Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A Lorch
- Department of Urology, Genitourinary Medical Oncology, Heinrich-Heine University Hospital Düsseldorf, Düsseldorf, Germany
| | - A Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - N Nicolai
- Department of Surgery, Urology and Testis Surgery Unit, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - C Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany
| | - J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | - D Ondruš
- 1st Department of Oncology, St. Elisabeth Cancer Institute, Comenius University Faculty of Medicine, Bratislava, Slovak Republic
| | - A Papachristofilou
- Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - T Powles
- Department of Medical Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - A Sohaib
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | - O Ståhl
- Department of Oncology, Skane University Hospital, Lund University, Lund, Sweden
| | - T Tandstad
- The Cancer Clinic, St. Olavs Hospital, Trondheim, Norway
| | - G Toner
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia
| | - A Horwich
- The Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
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High Endogenous DNA Damage Levels Predict Hematological Toxicity in Testicular Germ Cell Tumor Patients Treated With First-Line Chemotherapy. Clin Genitourin Cancer 2019; 17:e1020-e1025. [PMID: 31281064 DOI: 10.1016/j.clgc.2019.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/24/2019] [Accepted: 06/03/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Testicular germ cell tumors (TGCTs) are an excellent example of chemosensitive disease. However, cisplatin-based chemotherapy has significant side effects, including myelosuppression. Previously, we found endogenous DNA damage level in peripheral blood mononuclear cells (PBMCs) to be an independent prognostic marker. In this study, we tested the hypothesis that patients with high endogenous DNA damage levels in PBMCs have an increased risk of developing hematological toxicity. PATIENTS AND METHODS One hundred twenty chemotherapy-naive TGCT patients treated in the National Cancer Institute and the St Elisabeth Cancer Institute in Bratislava, Slovakia, from 2012 to 2018 were enrolled. All patients received platinum-based chemotherapy with granulocyte colony stimulating factor support. On the day of starting treatment, we measured the DNA damage levels in PBMCs using the comet assay. We used the cutoff level of 5.25, a value previously reported to stratify patients on the basis of their prognosis. We monitored hematological toxicity during the first cycle of chemotherapy. The mean and standard error of the mean were calculated for all variables. RESULTS Patients with high DNA damage levels (>5.25) had more significant hematological toxicity with significantly lower nadir white blood cell count (P = .001), absolute neutrophil count (P = .013) and absolute lymphocyte count (ALC; P < .001). ALCs on day 0 (P = .005) and day 22 (P = .046) were also significantly lower in patients with high DNA damage levels. CONCLUSION This study shows that higher endogenous DNA damage levels correlate with increased risk of hematological toxicity in TGCT patients. Hence, the DNA damage levels can be used to select patients for closer monitoring because of a higher risk of acute chemotherapy-related complications.
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18
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Ghazarian AA, Rusner C, Trabert B, Braunlin M, McGlynn KA, Stang A. Testicular cancer among US men aged 50 years and older. Cancer Epidemiol 2019; 55:68-72. [PMID: 29807233 DOI: 10.1016/j.canep.2018.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND The incidence of testicular cancer in the United States (US) has substantially increased in recent decades. The majority of testicular cancers are germ cell tumors (TGCT), which are the most commonly occurring malignancies among men aged 15-44 years in the US. To date, few studies have focused on testicular cancer among men aged ≥ 50 years. Thus, we sought to examine detailed descriptive features, including incidence rates and age patterns, of tumors that arise in the testes among men aged ≥ 50 years. METHODS Data from forty-one US cancer registries were included for the years 1999-2014. Incidence rates per 100,000 person-years and their 95% confidence intervals (CI) were calculated by race/ethnicity, histology, and age at diagnosis. Estimates of annual percent change (APC) were also calculated. RESULTS Age-specific incidence rates of spermatocytic tumors, sex cord stromal tumors and lymphomas rose with age, while age-specific incidence rates of seminomas and nonseminomas declined. Between 1999 and 2014, the incidence of nonseminoma (APC = 3.26, 95% CI: 2.27-4.25) increased more than any other tumor type. The incidence of seminoma (APC: 1.15, 95% CI: 0.59-1.71) also increased, while rates of testicular lymphoma (APC: -0.66, 95% CI: -1.16 to -0.16), spermatocytic tumors (APC: 0.42, 95% CI: -1.42 to 2.29), and sex cord stromal tumors (APC: 0.60, 95% CI: -3.21 to 4.55) remained relatively unchanged. CONCLUSION Given the distinct time-trends and age-specific patterns of testicular cancer in men aged ≥50 years, additional investigation of risk factors for these tumors is warranted.
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Affiliation(s)
- Armen A Ghazarian
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA; Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Carsten Rusner
- Department of Radiology, St. Elisabeth and St. Barbara Hospital, Halle (Saale), Germany
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Megan Braunlin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
| | - Andreas Stang
- Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany; Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA; German Consortium of Translational Cancer Research (DKTK), Partner Site University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
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Terbuch A, Posch F, Partl R, Zurl B, Bauernhofer T, Pichler M, Szkandera J, Hutterer GC, Pummer K, Kapp KS, Stöger H, Gerger A, Stotz M. Risk stratification for febrile neutropenia in patients with testicular germ cell tumors. Cancer Med 2018; 7:508-514. [PMID: 29349917 PMCID: PMC5806095 DOI: 10.1002/cam4.1317] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to detect risk factors for febrile neutropenia (FN) in patients with testicular germ cell tumors (TGCT). In this retrospective cohort study at the Medical University of Graz, we included 413 consecutive TGCT patients who received adjuvant or curative treatment with cisplatin-based chemotherapy. FN occurred in 70 (16.9%) of 413 patients. In univariable logistic regression, higher age (odds ratio (OR) per 5 years = 1.17, 95% CI: 1.02-1.35, P = 0.022), reduced performance status (PS) (OR = 2.73, 1.47-5.06, P = 0.001), seminomatous histology (OR = 2.19, 1.26-3.78, P = 0.005), poor IGCCCG risk class (OR = 4.20, 1.71-10.33, P = 0.002), and prior radiotherapy (pRTX) (OR = 8.98, 2.09-38.61, P = 0.003) were associated with a higher risk of FN. In multivariable analysis adjusting for age and risk classification, only poor PS (OR = 2.06, 1.05-4.03, P = 0.035), seminomatous histology (OR = 2.08, 1.01-4.26, P = 0.047), and pRTX (OR = 7.31, 1.61-33.17, P = 0.010) prevailed. In the subgroup of seminoma patients (n = 104), only pRTX predicted for FN risk (OR = 5.60, 1.24-25.34, P = 0.025). Five of eight seminoma patients with pRTX developed FN (63%), as compared to 22 FN cases (23%) in the 96 seminoma patients without pRTX (P = 0.027). The eight seminoma patients who received pRTX had significantly lower pre-chemo white blood counts (4.7 vs. 6.5 G/L), neutrophil counts (3.2 vs. 4.3 G/L), and platelet counts (185 vs. 272 G/L) than patients without pRTX (all P < 0.0001). TGCT patients with a reduced performance status or who had been previously treated with radiotherapy have an increased risk for neutropenic fever during chemotherapy.
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Affiliation(s)
- Angelika Terbuch
- Division of OncologyDepartment of Internal MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
- Research Unit Genetic Epidemiology and PharmacogeneticsMedical University of GrazGrazAustria
| | - Florian Posch
- Division of OncologyDepartment of Internal MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
- Research Unit Genetic Epidemiology and PharmacogeneticsMedical University of GrazGrazAustria
| | - Richard Partl
- Department of Therapeutic Radiology and OncologyComprehensive Cancer Center GrazMedical University of GrazGrazAustria
| | - Brigitte Zurl
- Department of Therapeutic Radiology and OncologyComprehensive Cancer Center GrazMedical University of GrazGrazAustria
| | - Thomas Bauernhofer
- Division of OncologyDepartment of Internal MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
- Center for Biomarker Research in Medicine (CBmed)GrazAustria
| | - Martin Pichler
- Division of OncologyDepartment of Internal MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
- Department of Experimental TherapeuticsThe University of TexasMD Anderson Cancer CenterHoustonTexas
| | - Joanna Szkandera
- Division of OncologyDepartment of Internal MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
| | | | - Karl Pummer
- Department of UrologyMedical University of GrazGrazAustria
| | - Karin S. Kapp
- Department of Therapeutic Radiology and OncologyComprehensive Cancer Center GrazMedical University of GrazGrazAustria
| | - Herbert Stöger
- Division of OncologyDepartment of Internal MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
| | - Armin Gerger
- Division of OncologyDepartment of Internal MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
- Research Unit Genetic Epidemiology and PharmacogeneticsMedical University of GrazGrazAustria
- Center for Biomarker Research in Medicine (CBmed)GrazAustria
| | - Michael Stotz
- Division of OncologyDepartment of Internal MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
- Research Unit Genetic Epidemiology and PharmacogeneticsMedical University of GrazGrazAustria
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Patterns of care and survival outcomes for adolescent and young adult patients with testicular seminoma in the United States: A National Cancer Database analysis. J Pediatr Urol 2017; 13:386.e1-386.e7. [PMID: 28153774 DOI: 10.1016/j.jpurol.2016.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 12/07/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Testicular germ cell tumors (GCTs) are the most common solid tumor among adolescent and young adult (AYA) males. AYA patients with GCTs most typically have non-seminoma compared with seminoma, and accordingly there are fewer data reported on the AYA experience with testicular seminoma. OBJECTIVE To evaluate national trends in postoperative treatment and overall survival (OS) outcomes in testicular seminoma by age group, specifically comparing AYAs with older adults. STUDY DESIGN The National Cancer Data Base (NCDB) was queried for patients with testicular seminoma diagnosed between 2004 and 2012, who underwent orchiectomy followed by observation or adjuvant therapy (chemotherapy, radiation (RT), or both). Patients were grouped by age: AYA (15-39 years), adults between 40 and 55 years, and adults >55 years. Overall survival (OS) was presented using Kaplan-Meier curves and groups compared via a log-rank test. Univariate (UVA) and multivariate (MVA) analyses were performed using Cox proportional hazards regression models. Binary multiple logistic regression identified differences in variables by age category. RESULTS Of the total 22,361 patients the majority were AYAs (12,880, 57.6%), followed by adults 40-55 years (8,022, 35.9%), and >55 years (1,459, 6.5%). Unadjusted 5-year OS was significantly better for AYAs versus adults 40-55 years and >55 years (98.0%, 96.4%, 87.7%; p < 0.001), as was 10-year OS (96.1%, 91.8%, 71.3% respectively; p < 0.001). The Table shows that on a MVA, OS was significantly better for AYAs versus adults 40-55 years and adults >55 years. AYA patients were also more commonly treated at centers with greater clinical volume. Additionally, AYA patients were less likely to present with metastatic disease. Accordingly, AYA patients were less likely to undergo retroperitoneal lymph node dissection (OR 0.81; p = 0.001) and were less often managed with adjuvant therapy including chemotherapy (OR 0.91; p = 0.027), RT (OR 0.93; p = 0.025), or both (OR 0.68; p = 0.020). DISCUSSION AYA patients with testicular seminoma present with earlier stage disease and in the clinical Stage I setting are more often are managed with active surveillance following orchiectomy when compared with older adults in this population-based analysis. Among AYA patients, OS was modestly better when compared with adults 40-55 years and significantly better when compared with adults >55 years. CONCLUSION Our objective to describe the patterns of care and survival outcomes for AYA patients with testicular seminoma in the USA was met by reviewing this large national dataset. These results may inform future guidelines for management of AYA seminoma.
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Necchi A, Lo Vullo S, Rosti G, Badoglio M, Giannatempo P, Raggi D, Secondino S, Mariani L, Lanza F, Pedrazzoli P. Administration of high-dose chemotherapy with stem cell support in patients 40 years of age or older with advanced germ cell tumours: a retrospective study from the European Society for Blood and Marrow Transplantation database. Bone Marrow Transplant 2017; 52:1218-1220. [DOI: 10.1038/bmt.2017.106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kawai T, Tanaka Y. Clinical characteristics of testicular germ cell tumors in patients aged 50 years and older: A large-scale study from the Cancer Registration Committee of the Japanese Urological Association. Int J Urol 2016; 24:124-128. [DOI: 10.1111/iju.13268] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 11/04/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Taketo Kawai
- Department of Urology; Japanese Red Cross Musashino Hospital; Musashino Tokyo Japan
| | - Yoshinori Tanaka
- Department of Urology; Japanese Red Cross Musashino Hospital; Musashino Tokyo Japan
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A Rare Case of Primary Anterior Mediastinal Yolk Sac Tumor in an Elderly Adult Male. Case Rep Oncol Med 2016; 2016:8961486. [PMID: 27144043 PMCID: PMC4837257 DOI: 10.1155/2016/8961486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/22/2016] [Indexed: 11/18/2022] Open
Abstract
Mediastinal germ cell tumors are extragonadal germ cell tumors (EGGCTs) commonly seen in children and young adults. They are more common in men. Clinically they are classified as teratomas, seminomas, and nonseminomatous germ cell tumors. Primary mediastinal yolk sac neoplasm is an extremely rare tumor. We present here a very rare case of primary yolk sac tumor of the anterior mediastinum in a 73-year-old male. Mediastinal germ cell tumors have a worse prognosis than gonadal germ cell tumors. Chemotherapy followed by adjuvant surgery improves overall response in EGGCTs. However, comorbidities can render treatment with chemotherapy and surgery challenging in elderly patients.
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Ko JJ, Bernard B, Tran B, Li H, Asif T, Stukalin I, Lee M, Day D, Alimohamed N, Sweeney CJ, Bedard PL, Heng DY. Conditional Survival of Patients With Metastatic Testicular Germ Cell Tumors Treated With First-Line Curative Therapy. J Clin Oncol 2016; 34:714-20. [DOI: 10.1200/jco.2015.64.7909] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose The International Germ Cell Cancer Collaborative Group (IGCCCG) criteria prognosticate survival outcomes in metastatic testicular germ cell tumor (MT-GCT), but how the initial risk changes over time for those who survived since curative treatment is unknown. Patients and Methods We assessed patients eligible for first-line therapy for MT-GCT at five tertiary cancer centers from 1990 to 2012 for 2-year conditional overall survival (COS) and conditional disease-free survival (CDFS), defined as the probability of surviving, or surviving and being disease free, respectively, for an additional 2 years at a given time point since the initial diagnosis. Results For all patients (N = 942), 2-year COS increased from 92% (95% CI, 91% to 94%) at 0 months to 98% (95% CI, 97% to 99%), and 2-year CDFS increased from 83% (95% CI, 81% to 86%) at baseline to 98% (95% CI, 97% to 99%) at 24 months after diagnosis. Two-year COS improved by 2% (97% at 0 months, 99% at 24 months) in the IGCCCG favorable-risk group, by 5% (94% at 0 months, 99% at 24 months) in the intermediate-risk group, and by 22% (71% at 0 months to 93% at 24 months) in the poor-risk group. Two-year CDFS improved significantly at 12 months for each risk group (favorable, 91% baseline v 95% at 12 months; intermediate, 84% v 95%; poor, 55% v 85%). Baseline IGCCCG risk stratification was not associated with long-term COS or CDFS for patients who survived to greater than 2 years post therapy. No significant differences in COS and CDFS were noted between seminoma and nonseminoma; patients ≥ 40 years old had inferior 2-year COS from 0 to 12 months, but no differences were noted at 18 months. Conclusion Our data suggest that the concept of conditional survival applies to patients with MT-GCT treated with curative therapy. Patients with MT-GCT who survived and remained disease free more than 2 years after the diagnosis had an excellent chance of staying alive and disease free in additional subsequent years, regardless of the initial IGCCCG risk stratification.
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Affiliation(s)
- Jenny J. Ko
- Jenny J. Ko, Abbotsford Cancer Agency, Abbotsford, British Columbia; Haocheng Li, University of Calgary; Igor Stukalin, Nimira Alimohamed, and Daniel Y.C. Heng, Tom Baker Cancer Center, Calgary, Alberta; Tehmina Asif, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan; Daphne Day and Philippe L. Bedard, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Brandon Bernard and Christopher J. Sweeney, Dana Farber Cancer Institute, Boston, MA; and Ben Tran and Margaret Lee, Royal Melbourne Hospital,
| | - Brandon Bernard
- Jenny J. Ko, Abbotsford Cancer Agency, Abbotsford, British Columbia; Haocheng Li, University of Calgary; Igor Stukalin, Nimira Alimohamed, and Daniel Y.C. Heng, Tom Baker Cancer Center, Calgary, Alberta; Tehmina Asif, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan; Daphne Day and Philippe L. Bedard, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Brandon Bernard and Christopher J. Sweeney, Dana Farber Cancer Institute, Boston, MA; and Ben Tran and Margaret Lee, Royal Melbourne Hospital,
| | - Ben Tran
- Jenny J. Ko, Abbotsford Cancer Agency, Abbotsford, British Columbia; Haocheng Li, University of Calgary; Igor Stukalin, Nimira Alimohamed, and Daniel Y.C. Heng, Tom Baker Cancer Center, Calgary, Alberta; Tehmina Asif, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan; Daphne Day and Philippe L. Bedard, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Brandon Bernard and Christopher J. Sweeney, Dana Farber Cancer Institute, Boston, MA; and Ben Tran and Margaret Lee, Royal Melbourne Hospital,
| | - Haocheng Li
- Jenny J. Ko, Abbotsford Cancer Agency, Abbotsford, British Columbia; Haocheng Li, University of Calgary; Igor Stukalin, Nimira Alimohamed, and Daniel Y.C. Heng, Tom Baker Cancer Center, Calgary, Alberta; Tehmina Asif, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan; Daphne Day and Philippe L. Bedard, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Brandon Bernard and Christopher J. Sweeney, Dana Farber Cancer Institute, Boston, MA; and Ben Tran and Margaret Lee, Royal Melbourne Hospital,
| | - Tehmina Asif
- Jenny J. Ko, Abbotsford Cancer Agency, Abbotsford, British Columbia; Haocheng Li, University of Calgary; Igor Stukalin, Nimira Alimohamed, and Daniel Y.C. Heng, Tom Baker Cancer Center, Calgary, Alberta; Tehmina Asif, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan; Daphne Day and Philippe L. Bedard, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Brandon Bernard and Christopher J. Sweeney, Dana Farber Cancer Institute, Boston, MA; and Ben Tran and Margaret Lee, Royal Melbourne Hospital,
| | - Igor Stukalin
- Jenny J. Ko, Abbotsford Cancer Agency, Abbotsford, British Columbia; Haocheng Li, University of Calgary; Igor Stukalin, Nimira Alimohamed, and Daniel Y.C. Heng, Tom Baker Cancer Center, Calgary, Alberta; Tehmina Asif, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan; Daphne Day and Philippe L. Bedard, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Brandon Bernard and Christopher J. Sweeney, Dana Farber Cancer Institute, Boston, MA; and Ben Tran and Margaret Lee, Royal Melbourne Hospital,
| | - Margaret Lee
- Jenny J. Ko, Abbotsford Cancer Agency, Abbotsford, British Columbia; Haocheng Li, University of Calgary; Igor Stukalin, Nimira Alimohamed, and Daniel Y.C. Heng, Tom Baker Cancer Center, Calgary, Alberta; Tehmina Asif, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan; Daphne Day and Philippe L. Bedard, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Brandon Bernard and Christopher J. Sweeney, Dana Farber Cancer Institute, Boston, MA; and Ben Tran and Margaret Lee, Royal Melbourne Hospital,
| | - Daphne Day
- Jenny J. Ko, Abbotsford Cancer Agency, Abbotsford, British Columbia; Haocheng Li, University of Calgary; Igor Stukalin, Nimira Alimohamed, and Daniel Y.C. Heng, Tom Baker Cancer Center, Calgary, Alberta; Tehmina Asif, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan; Daphne Day and Philippe L. Bedard, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Brandon Bernard and Christopher J. Sweeney, Dana Farber Cancer Institute, Boston, MA; and Ben Tran and Margaret Lee, Royal Melbourne Hospital,
| | - Nimira Alimohamed
- Jenny J. Ko, Abbotsford Cancer Agency, Abbotsford, British Columbia; Haocheng Li, University of Calgary; Igor Stukalin, Nimira Alimohamed, and Daniel Y.C. Heng, Tom Baker Cancer Center, Calgary, Alberta; Tehmina Asif, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan; Daphne Day and Philippe L. Bedard, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Brandon Bernard and Christopher J. Sweeney, Dana Farber Cancer Institute, Boston, MA; and Ben Tran and Margaret Lee, Royal Melbourne Hospital,
| | - Christopher J. Sweeney
- Jenny J. Ko, Abbotsford Cancer Agency, Abbotsford, British Columbia; Haocheng Li, University of Calgary; Igor Stukalin, Nimira Alimohamed, and Daniel Y.C. Heng, Tom Baker Cancer Center, Calgary, Alberta; Tehmina Asif, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan; Daphne Day and Philippe L. Bedard, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Brandon Bernard and Christopher J. Sweeney, Dana Farber Cancer Institute, Boston, MA; and Ben Tran and Margaret Lee, Royal Melbourne Hospital,
| | - Philippe L. Bedard
- Jenny J. Ko, Abbotsford Cancer Agency, Abbotsford, British Columbia; Haocheng Li, University of Calgary; Igor Stukalin, Nimira Alimohamed, and Daniel Y.C. Heng, Tom Baker Cancer Center, Calgary, Alberta; Tehmina Asif, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan; Daphne Day and Philippe L. Bedard, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Brandon Bernard and Christopher J. Sweeney, Dana Farber Cancer Institute, Boston, MA; and Ben Tran and Margaret Lee, Royal Melbourne Hospital,
| | - Daniel Y.C. Heng
- Jenny J. Ko, Abbotsford Cancer Agency, Abbotsford, British Columbia; Haocheng Li, University of Calgary; Igor Stukalin, Nimira Alimohamed, and Daniel Y.C. Heng, Tom Baker Cancer Center, Calgary, Alberta; Tehmina Asif, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan; Daphne Day and Philippe L. Bedard, Princess Margaret Cancer Center, Toronto, Ontario, Canada; Brandon Bernard and Christopher J. Sweeney, Dana Farber Cancer Institute, Boston, MA; and Ben Tran and Margaret Lee, Royal Melbourne Hospital,
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Dorff TB, Hu J, Quinn DI. Relapsed and refractory germ cell tumors: Finessing the rough end of a beautiful story. Urol Oncol 2015; 33:341-2. [PMID: 26094170 PMCID: PMC9985443 DOI: 10.1016/j.urolonc.2015.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 05/21/2015] [Indexed: 10/23/2022]
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Zores T, Mouracade P, Duclos B, Saussine C, Lang H, Jacqmin D. Surveillance des séminomes testiculaires de stade I : résultats oncologiques sur 20ans. Prog Urol 2015; 25:282-7. [DOI: 10.1016/j.purol.2015.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 01/13/2015] [Indexed: 11/30/2022]
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Lin KY, Bryant S, Miller DS, Kehoe SM, Richardson DL, Lea JS. Malignant ovarian germ cell tumor - role of surgical staging and gonadal dysgenesis. Gynecol Oncol 2014; 134:84-9. [PMID: 24836278 DOI: 10.1016/j.ygyno.2014.05.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 05/05/2014] [Accepted: 05/08/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the effect of comprehensive surgical staging and gonadal dysgenesis on the outcomes of patients with malignant ovarian germ cell tumor. METHODS We performed a retrospective review of patients with ovarian germ cell tumors who were treated at our institution between 1976 and 2012. RESULTS Malignant ovarian germ cell tumors (MOGCTs) were identified in 50 females. The median age was 24 years (range 13 to 49). Of all MOGCT patients, 42% had dysgerminoma, 20% immature teratoma, 16% endodermal sinus tumor, and 22% mixed germ cell tumor. Univariate analyses revealed that the lack of surgical staging (p=0.048) and endodermal sinus tumor (p=0.0085) were associated with disease recurrence, while age at diagnosis, ethnicity, and stage of the disease were not. Multivariate analyses revealed that the lack of surgical staging (p=0.029) and endodermal sinus tumor (p=0.016) were independently associated with disease recurrence. In addition, 7 patients (14%) had 46 XY karyotype, including 6 with pure dysgerminoma and 1 with mixed germ cell tumor. Five had Swyer syndrome and 2 had complete androgen insensitivity syndrome. Concurrent gonadoblastoma was found in 5 of the patients. No difference was found in the mean age at presentation, stage distribution, or recurrence rate for MOGCT patients with or without XY phenotype. CONCLUSIONS Comprehensive surgical staging was associated with a lower rate of recurrence. Fourteen percent of phenotypic females with MOGCT and 29% of those with dysgerminoma had XY karyotype. The clinical outcome of these patients is similar to that of MOGCT patients with XX karyotype.
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Affiliation(s)
- Ken Y Lin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Stefanie Bryant
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David S Miller
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Siobhan M Kehoe
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Debra L Richardson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jayanthi S Lea
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Thomsen FB, Bandak M, Thomsen MF, Lauritsen J, Christensen IJ, Daugaard G. Survival and toxicity in patients with disseminated germ cell cancer aged 40 years and older. Cancer 2013; 120:43-51. [DOI: 10.1002/cncr.28374] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/16/2013] [Accepted: 08/19/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Frederik B. Thomsen
- Copenhagen Prostate Cancer Center; Department of Urology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Mikkel Bandak
- Department of Oncology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Maria F. Thomsen
- Department of Internal Medicine; Amager Hospital; Copenhagen Denmark
| | - Jakob Lauritsen
- Department of Oncology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Ib J. Christensen
- The Finsen Laboratory; Rigshospitalet and Biotech Research and Innovation Center; University of Copenhagen; Denmark
| | - Gedske Daugaard
- Department of Oncology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
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