1
|
Bansal C, Singh A, Kapoor D, Nayyar C, Shaikh MN, Swami PC. Cytodiagnostic Dilemma in a Lung Mass as the First Presentation of Testicular Mixed Germ Cell Tumor Metastasis. Indian J Surg Oncol 2024; 15:168-171. [PMID: 38511017 PMCID: PMC10948662 DOI: 10.1007/s13193-023-01850-5] [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: 10/16/2023] [Accepted: 11/11/2023] [Indexed: 03/22/2024] Open
Abstract
Testicular mixed germ cell tumors (TMGCTs) are rare malignant tumors comprising of two or more types of germ cell tumors. Their onset may be undetectable and the patient may first present with symptoms of metastasis. We hereby report a case of a young male who presented with respiratory discomfort and had no symptoms of primary testicular tumor. CT-guided FNAC lung revealed mainly necrotic, keratinous debris with a focus of chondromyxoid stroma. Differential diagnoses of components of teratoma, squamous cell carcinoma and inclusion cyst was considered. FNAC was reported out for the possible presence of teratoma components. Retrospectively, physical examination and subsequent USG revealed testicular tumor. The case led to a diagnostic dilemma as the patient presented with no prior history suggestive of metastasis from testicular mixed germ cell tumor. The aim of the current case report is to alert the pathologists and clinicians about this uncommon clinical presentation and diagnostic relevance of FNA. It highlights that FNA lung revealing keratinous material should always be searched for the possibility of teratoma component.
Collapse
Affiliation(s)
- Cherry Bansal
- Department of Pathology, Dr S S Tantia Medical College, Hospital & Research Center, Sri Ganganagar, Rajasthan India
| | - Amanpreet Singh
- Department of Pathology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab India
| | - Dimple Kapoor
- Department of Pathology, Dr S S Tantia Medical College, Hospital & Research Center, Sri Ganganagar, Rajasthan India
| | - Charu Nayyar
- Department of Microbiology, Dr S S Tantia Medical College, Hospital & Research Center, Sri Ganganagar, Rajasthan India
| | - Mohammed Nadeem Shaikh
- Department of Biochemistry, Dr S S Tantia Medical College, Hospital & Research Center, Sri Ganganagar, Rajasthan India
| | - P. C. Swami
- Department of Oral & Maxillofacial Surgery, Dr S S Tantia Medical College, Hospital & Research Center, Sri Ganganagar, Rajasthan India
| |
Collapse
|
2
|
McHugh DJ, Gleeson JP, Feldman DR. Testicular cancer in 2023: Current status and recent progress. CA Cancer J Clin 2024; 74:167-186. [PMID: 37947355 DOI: 10.3322/caac.21819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 11/12/2023] Open
Abstract
Testicular germ cell tumor (GCT) is the most common solid tumor in adolescent and young adult men. Progress in the management of GCT has been made in the last 50 years, with a substantial improvement in cure rates for advanced disease, from 25% in the 1970s to nearly 80%. However, relapsed or platinum-refractory disease occurs in a proportion, 20% of whom will die from disease progression. This article reviews the current evidence-based treatments for extracranial GCT, the acute and chronic toxic effects that may result, and highlights contemporary advances and progress in the field.
Collapse
Affiliation(s)
- Deaglan J McHugh
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medicine, New York, New York, USA
| | - Jack P Gleeson
- Cancer Research, College of Medicine and Health, University College Cork, Cork, Ireland
- Medical Oncology Department, Cork University Hospital, Cork, Ireland
| | - Darren R Feldman
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
3
|
Ríos-Rodríguez JA, Montalvo-Casimiro M, Álvarez-López DI, Reynoso-Noverón N, Cuevas-Estrada B, Mendoza-Pérez J, Jiménez-Ríos MA, Wegman-Ostrosky T, Salcedo-Tello P, Scavuzzo A, Castro-Hernández C, Herrera LA, González-Barrios R. Understanding Sociodemographic Factors among Hispanics Through a Population-Based Study on Testicular Cancer in Mexico. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01859-0. [PMID: 37962789 DOI: 10.1007/s40615-023-01859-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023]
Abstract
Testicular cancer (TCa) is a rare malignancy affecting young men worldwide. Sociodemographic factors, especially socioeconomic level (SEL) and healthcare access, seem to impact TCa incidence and outcomes, particularly among Hispanic populations. However, limited research has explored these variables in Hispanic groups. This study aimed to investigate sociodemographic and clinical factors in Mexico and their role in health disparities among Hispanic TCa patients. We retrospectively analyzed 244 Mexican TCa cases between 2007 and 2020 of a representative cohort with diverse social backgrounds from a national reference cancer center. Logistic regression identified risk factors for fatality: non-seminoma histology, advanced stage, and lower education levels. Age showed a significant trend as a risk factor. Patient delay and healthcare distance lacked significant associations. Inadequate treatment response and chemotherapy resistance were more likely in advanced stages, while higher education positively impacted treatment response. Cox regression highlighted non-seminoma histology, below-median SEL, higher education, and advanced-stage survival rates. Survival disparities emerged based on tumor histology and patient SEL. This research underscores the importance of comprehensive approaches that integrate sociodemographic, biological, and environmental factors to address health disparities improving outcomes through personalized interventions in Hispanic individuals with TCa.
Collapse
Affiliation(s)
- Juan Alberto Ríos-Rodríguez
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, Mexico City, 14080, México
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de La Salud, Monterrey, 64710, México
| | - Michel Montalvo-Casimiro
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, Mexico City, 14080, México
| | - Diego Ivar Álvarez-López
- Unidad de Epidemiología en Cáncer, Instituto Nacional de Cancerología, Mexico City, 14080, México
| | - Nancy Reynoso-Noverón
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, Mexico City, 14080, México
- Unidad de Epidemiología en Cáncer, Instituto Nacional de Cancerología, Mexico City, 14080, México
| | - Berenice Cuevas-Estrada
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, Mexico City, 14080, México
| | - Julia Mendoza-Pérez
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Miguel A Jiménez-Ríos
- Departamento de Urología, Instituto Nacional de Cancerología, Mexico City, 14080, México
| | - Talia Wegman-Ostrosky
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, Mexico City, 14080, México
| | - Pamela Salcedo-Tello
- Departamento de Bioquímica, Facultad de Medicina, UNAM, Mexico City, 04510, México
| | - Anna Scavuzzo
- Departamento de Urología, Instituto Nacional de Cancerología, Mexico City, 14080, México
| | - Clementina Castro-Hernández
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, Mexico City, 14080, México
| | - Luis A Herrera
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, Mexico City, 14080, México.
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de La Salud, Monterrey, 64710, México.
| | - Rodrigo González-Barrios
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, Mexico City, 14080, México.
- Departamento de Biología Celular, Facultad de Ciencias, UNAM, Mexico City, 04510, México.
| |
Collapse
|
4
|
Yu H, Feng B, Zhang Y, Lyu J. Development and validation of a nomogram for predicting the overall survival of patients with testicular cancer. Cancer Med 2023; 12:15567-15578. [PMID: 37264772 PMCID: PMC10417196 DOI: 10.1002/cam4.6203] [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: 03/28/2023] [Revised: 04/25/2023] [Accepted: 05/23/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The purpose of this study was to develop and validate a nomogram to predict survival in testicular cancer patients. METHODS Testicular cancer patients diagnosed between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database were selected for this study. A random sampling method was used to divide patients into training and validation cohorts, which accounted for 30% and 70% of the total sample, respectively. The nomogram was developed using the training cohort and evaluated using the C index, calibration chart, and area under the receiver operating characteristic curve (AUC). RESULTS Seven risk factors that affect the survival of testicular cancer patients (AJCC stage, marital status, age at diagnosis, race, SEER historic stage A, surgery status, and origin) were identified using Cox proportional hazard regression analysis. The nomogram has a higher C index (0.897) and AUC when compared with the AJCC staging system. The results of the calibration chart of the nomogram show that the predicted survival of testicular cancer patients at 3, 5, and 10 years after diagnosis is very close to their actual survival. CONCLUSIONS We developed and validated a nomogram for predicting the survival rate of testicular cancer patients at 3, 5, and 10 years after diagnosis. This nomogram has better discrimination, calibration, and clinical validity than the AJCC staging system. This indicates that the nomogram can be used to predict the survival of testicular cancer patients effectively, and provide a reference for patient treatment strategies.
Collapse
Affiliation(s)
- Haohui Yu
- Department of Medical AdministrationThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Bin Feng
- Department of Medical AdministrationThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Yunrui Zhang
- Department of Medical AdministrationThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Jun Lyu
- Department of Medical AdministrationThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| |
Collapse
|
5
|
Törzsök P, Van Goubergen J, Pichler M, Pichler R, Santer FR. Isochromosome 12p Formation Regulates Vitamin D Metabolism in Testicular Cancer. Nutrients 2023; 15:nu15102384. [PMID: 37242266 DOI: 10.3390/nu15102384] [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: 04/13/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Isochromosome 12p (iChr12p) is typical in almost all invasive testicular cancers. Increased copy number of genes on 12p is associated with the development of a clinically manifest tumor; however, the causative genes have not yet been identified. Chromosome 12 harbors many genes involved in Vitamin D metabolism. RNAseq analysis of Vitamin D receptor (VDR) genes from the TCGA cohort revealed that clustering of VDR expression signatures could differentiate between pure seminomas and non-seminomatous germ cell tumors (NSGCT). Using TCGA mRNA expression of anabolic (CYP2R1, CYP27A1 and CYP27B1) and catabolic (CYP24A1) Vitamin D enzymes, positive (PTHLH, IFNG, and TNF) and negative (FGF23) feedback regulators could also clearly distinguish between pure seminomas and NSGCT. We hypothesize that the regulation of Vitamin D metabolism might be disturbed through iChr12p formation, influencing testicular carcinogenesis via increased FGF23 and PTHLH expression. While FGF23 represses CYP27B1 and activates catabolism of active hormone, increased PTHLH secretion can lead to hypercalcemia via inactivation of VDR. In conclusion, testicular cancer is associated with extensive modifications in intratesticular Vitamin D homeostasis. Further research is needed to clarify whether Vitamin D deficiency causes the formation of iChr12p and whether Vitamin D deficiency via iChr12p genomic aberration is involved in testicular carcinogenesis.
Collapse
Affiliation(s)
- Peter Törzsök
- Department of Urology and Andrology, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Jasper Van Goubergen
- Division of Experimental Urology, Department of Urology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Martin Pichler
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, 8010 Graz, Austria
- Translational Oncology, University Hospital of Augsburg, 86156 Augsburg, Germany
| | - Renate Pichler
- Department of Urology, Comprehensive Cancer Center Innsbruck, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Frédéric R Santer
- Division of Experimental Urology, Department of Urology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| |
Collapse
|
6
|
Angerer M, Wülfing C, Dieckmann KP. Familial Testicular Germ Cell Tumor in Two Brothers With Emery Dreifuss Muscular Dystrophy Caused by an FHL-1 Mutation: A Case Report. Cureus 2023; 15:e38946. [PMID: 37309342 PMCID: PMC10257954 DOI: 10.7759/cureus.38946] [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: 05/12/2023] [Indexed: 06/14/2023] Open
Abstract
Testicular germ cell tumor (GCT) is a rare disease, accounting for no more than 1.5% of all neoplasms in males, but represents the most common tumors in adolescents and young men in Western countries. There is also consensus about the involvement of genetic factors in the etiology of testicular GCT. Familial occurrence of testicular GCT is observed in 1-2% of all cases with GCT. We report the unique case of two brothers, both afflicted with inherited Emery-Dreifuss muscular dystrophy (EDMD) and both developing testicular GCT in young adulthood. EDMD is a rare muscular dystrophy, characterized by the triad of joint contractures, slowly progressive muscle weakness, and cardiac involvement. EDMD is not a homogeneous clinical entity because it is associated with various gene mutations. One common mutation relates to the Four and a half Limb domain protein 1 (FHL-1) gene. To date, there have been no GCT cases linked with FHL-1 mutations and no malignant disease has been found associated with EDMD.
Collapse
Affiliation(s)
- Markus Angerer
- Department of Urology, Asklepios Klinik Altona, Hamburg, DEU
| | | | | |
Collapse
|
7
|
Yazici S, Del Biondo D, Napodano G, Grillo M, Calace FP, Prezioso D, Crocetto F, Barone B. Risk Factors for Testicular Cancer: Environment, Genes and Infections-Is It All? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040724. [PMID: 37109682 PMCID: PMC10145700 DOI: 10.3390/medicina59040724] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/11/2023] [Accepted: 03/29/2023] [Indexed: 04/29/2023]
Abstract
The incidence of testicular cancer is steadily increasing over the past several decades in different developed countries. If on one side better diagnosis and treatment have shone a light on this disease, on the other side, differently from other malignant diseases, few risk factors have been identified. The reasons for the increase in testicular cancer are however unknown while risk factors are still poorly understood. Several studies have suggested that exposure to various factors in adolescence as well as in adulthood could be linked to the development of testicular cancer. Nevertheless, the role of environment, infections, and occupational exposure are undoubtedly associated with an increase or a decrease in this risk. The aim of this narrative review is to summarize the most recent evidence regarding the risk factors associated with testicular cancer, starting from the most commonly evaluated (cryptorchidism, family history, infections) to the newer identified and hypothesized risk factors.
Collapse
Affiliation(s)
- Sertac Yazici
- Department of Urology, Hacettepe University School of Medicine, 06230 Ankara, Turkey
| | - Dario Del Biondo
- Department of Urology, ASL NA1 Centro Ospedale del Mare, 80147 Naples, Italy
| | - Giorgio Napodano
- Department of Urology, ASL NA1 Centro Ospedale del Mare, 80147 Naples, Italy
| | - Marco Grillo
- Department of Urology, ASL NA1 Centro Ospedale del Mare, 80147 Naples, Italy
- University of Rome Tor Vergata, 00133 Rome, Italy
| | - Francesco Paolo Calace
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy
| | - Domenico Prezioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy
| | - Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy
| | - Biagio Barone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy
| |
Collapse
|
8
|
Demirci A, Başar H. Effects of epidemiological risk factors on prognosis in testicular cancer. Int Urol Nephrol 2023; 55:51-59. [PMID: 36103044 DOI: 10.1007/s11255-022-03359-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/25/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Testicular cancer is frequently seen, especially in young males, and constitutes 1% of all male cancers. Family history, testicular dysgenesis syndrome, and the presence of tumour in the contralateral testis are each well-defined epidemiological risk factors. The aim of the current study was to determine the distribution of these risk factors according to tumour stage and to evaluate the effects on progression. MATERIALS AND METHODS A total of 71 patients diagnosed with testicular cancer in our clinic between January 2018 and December 2021 were classified according to tumour stage (Group 1: Early, n = 29; Group 2: Advanced, n = 42). The presence of risk factors, and demographic and pathological data were recorded. RESULTS No significant difference was determined between the groups in respect of age, comorbidities, and tumour type (p > 0.05). There was no difference between Group 1 and Group 2 in terms of median follow-up time [15.5 (17.5), 16.5(26.5) months, respectively, p = 0.4]. Epidemiological risk factors were seen more in Group 2 than in Group 1 (p = 0.03). Progression-free survival was determined to be shorter in patients with risk factors compared to those without (7.95 ± 1.3 vs. 29.4 ± 2.06 months, p < 0.001, respectively). Family history and testicular dysgenesis syndrome were determined to be independent risk factors for progression [HR:0.046 (0.004-0.485); HR:0.101 (0.03-0.347), p < 0.05, respectively]. CONCLUSIONS More advanced-stage tumours are seen in patients with testicular cancer when epidemiological risk factors are also present. Of these risk factors, family history and testicular dysgenesis syndrome have a negative effect on progression.
Collapse
Affiliation(s)
- Aykut Demirci
- Department of Urology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey.
| | - Halil Başar
- Department of Urology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
9
|
Manolitsis I, Tzelves L, Bellos T, Berdempes M, Skolarikos A. Synchronous Testicular Cancer in Monozygotic Twins. Cureus 2022; 14:e22956. [PMID: 35411268 PMCID: PMC8989070 DOI: 10.7759/cureus.22956] [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] [Accepted: 03/08/2022] [Indexed: 11/05/2022] Open
Abstract
Testicular cancer is the most common neoplasm in men aged 15-45 years old, with several established risk factors such as cryptorchidism, age, and family history. We report a case of a 44-year-old man with a history of cryptorchidism who presented with lesions in his right testis, a large retroperitoneal mass, and diffuse nodal lesions in his lungs. He underwent radical orchiectomy that showed testicular cancer and was immediately inducted into systemic therapy based on bleomycin, etoposide, and cisplatin. Two weeks later, his monozygotic twin brother, also reporting cryptorchidism at a young age, presented with a painless mass in his left testis. He underwent radical orchiectomy that revealed testicular cancer and received adjuvant chemotherapy. The first patient, after two cycles of chemotherapy, suffered from an episode of massive hematochezia and died while his brother remains relapse-free.
Collapse
|
10
|
Abstract
Testicular cancer is a rare malignancy that demonstrates variability in histopathologic features, treatment protocols, and outcomes based on a patient's age at presentation. In the pediatric population, puberty provides an important timestamp for evaluating and understanding the disease process. Prepubertal males, often designated as < 11 years of age, are more likely to present with benign disease. In contrast, the majority of post-pubertal testicular masses are malignant. Other factors, such as race/ethnicity, family history, and personal medical history can influence a patient's risk for malignancy as well. Serum tumor markers (STM) and histologic evaluation are key for diagnosis and for determining management. While normal STMs in a pre-pubertal patient likely qualify a patient for testis-sparing surgery, radical orchiectomy is the gold standard for post-pubertal patients, regardless of STM levels. Cross-sectional imaging is essential for staging and may be done before or after surgical intervention depending on the clinical scenario. Excellent survival outcomes are often achieved regardless of disease risk, with low-stage disease managed safely with surveillance. Surveillance usually consists of STM and imaging monitoring. If adjuvant therapy is indicated, a multi-disciplinary team approach is paramount. This approach should include following pediatric vs. adult protocols based of the patient's pubertal status in order to achieve optimal oncologic outcomes.
Collapse
|
11
|
Marques-Pinto A, Gomes AI, Febra J, Rosendo E, Castanheira de Oliveira M, Fraga A, La Fuente de Carvalho J, Louro N. Specialist management of testicular cancer: Report of the last 10 years at a Portuguese tertiary referral academic centre. ACTA ACUST UNITED AC 2021; 93:153-157. [PMID: 34286547 DOI: 10.4081/aiua.2021.2.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/05/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To describe our experience on testicular cancer (TC) management, underlining the clinical/pathological scope, administered treatments, outcomes, and challenges. TC incidence is rising globally. The predominant histology is germ cell tumour (GCT). In most patients, orchiectomy is curative. Still, a significant proportion of patients will need further tailored treatment. Specialist Reference Centres have proven themselves successful in this setting. Published data regarding TC in Northern Portugal is lacking. METHODS Retrospective review of consecutive TC patients at a specialist tertiary referral academic centre between January 2010 and December 2020. Statistical analysis was performed using the STATA® version 13.1 software. Multivariate logistic and survival analyses were performed. RESULTS 125 patients met the inclusion criteria. The median age is 35 (28-40) years; 19% of patients had risk factors for TC - infertility being the most common (11%); 50% of patients wanted sperm cryopreservation prior to treatment; 68% of patients had stage I GCT, 16% stage II, and 17% stage III. Compared to seminoma, non-seminomatous GCT were associated with younger age (p < .001) and higher stages at diagnosis (p = .02); 24% of stage IA/B GCT underwent adjuvant chemotherapy; 47% of patients with metastatic GCT at presentation had refractory disease, requiring tailored treatment. The median follow-up time is 33 (13-65) months. There was no late relapse. The 5-year OS rate is 98.0%. The 5-year survival of metastatic disease is 95.8%. CONCLUSIONS Despite contemporary excellent cure rates, the challenges of testicular cancer management still endure, especially in advanced stages. Therefore, public awareness is recommended, in order to avoid late presentations - special attention should be given to those who have known risk factors. The existence of Reference Centres is of paramount importance in order to achieve the best outcomes possible.
Collapse
Affiliation(s)
| | | | - Joana Febra
- Medical Oncology Department, Centro Hospitalar Universitário do Porto.
| | - Eugénia Rosendo
- Medical Oncology Department, Centro Hospitalar Universitário do Porto.
| | | | - Avelino Fraga
- Urology Department, Centro Hospitalar Universitário do Porto; Instituto de Ciências Biomédicas Abel Salazar, Porto.
| | - José La Fuente de Carvalho
- Urology Department, Centro Hospitalar Universitário do Porto; Instituto de Ciências Biomédicas Abel Salazar, Porto.
| | - Nuno Louro
- Urology Department, Centro Hospitalar Universitário do Porto; Instituto de Ciências Biomédicas Abel Salazar, Porto.
| |
Collapse
|
12
|
Nicholls PK, Page DC. Germ cell determination and the developmental origin of germ cell tumors. Development 2021; 148:239824. [PMID: 33913479 DOI: 10.1242/dev.198150] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In each generation, the germline is tasked with producing somatic lineages that form the body, and segregating a population of cells for gametogenesis. During animal development, when do cells of the germline irreversibly commit to producing gametes? Integrating findings from diverse species, we conclude that the final commitment of the germline to gametogenesis - the process of germ cell determination - occurs after primordial germ cells (PGCs) colonize the gonads. Combining this understanding with medical findings, we present a model whereby germ cell tumors arise from cells that failed to undertake germ cell determination, regardless of their having colonized the gonads. We propose that the diversity of cell types present in these tumors reflects the broad developmental potential of migratory PGCs.
Collapse
Affiliation(s)
- Peter K Nicholls
- Whitehead Institute, 455 Main Street, Cambridge, MA 02142, USA.,Faculty of Life Sciences, University of Bradford, Bradford BD7 1DP, UK
| | - David C Page
- Whitehead Institute, 455 Main Street, Cambridge, MA 02142, USA.,Department of Biology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Howard Hughes Medical Institute, Whitehead Institute, Cambridge, MA 02142, USA
| |
Collapse
|
13
|
Abstract
PURPOSE OF REVIEW Understanding the molecular basis underlying testicular germ cell tumors (TGCTs) may help improve patient outcomes, particularly for patients with poorer risk or chemoresistant disease. Here, we review the major contemporary advances in elucidating TGCT genetics by discussing patterns of TGCT inheritance, recent genomic and transcriptomic discoveries in TGCT, and the role of genetics in predicting therapeutic resistance and in guiding treatment. RECENT FINDINGS In the absence of a major high-penetrance TGCT susceptibility gene, inheritance is likely driven by a complex polygenic model with considerable variation. The most common genomic alterations found in TGCTs include gains in chromosome 12p and mutations in KIT, KRAS, and NRAS, particularly in seminomas. Sensitivity to cisplatin-based chemotherapy likely relies on intact TP53, reciprocal loss of heterozygosity, and high mitochondrial priming. Targetable mutations are uncommon in TGCTs, however, posing a challenge for the development of effective personalized therapies. Consistent with the characteristically low tumor mutational burden, immune checkpoint inhibitors do not appear to be effective for most TGCTs. SUMMARY Refinements in next-generation sequencing techniques over the last few years have enabled considerable advances in elucidating the genomic, transcriptomic, and epigenetic landscape of TGCTs. Future efforts focused on developing novel treatment modalities are needed.
Collapse
|
14
|
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: 192] [Impact Index Per Article: 38.4] [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.
Collapse
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
| |
Collapse
|
15
|
Abhulimen V, Raphael EJ. Testicular Cancer at the University of Port Harcourt Teaching Hospital: A 10-year Retrospective Review. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2019; 9:21-26. [PMID: 35520106 PMCID: PMC9063532 DOI: 10.4103/jwas.jwas_903_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 02/10/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Testicular cancers are rare malignancies. They are however very common in males aged 15-40 years. Reports of increasing incidence of testicular cancer in western countries have been noted. Despite the increasing incidence, mortality has remained low in these countries. There are few publications on the management of testicular tumors in Nigeria. AIM The aim of this study was to determine the hospital prevalence and highlight our experience in the management of patients with testicular cancer. MATERIALS AND METHODS This was a 10-year retrospective study on patients diagnosed with histologically confirmed testicular cancer from January 2009 to December 2018. The case records were retrieved. Data obtained included biodata, clinical presentation, investigations, treatment received and outcomes. Data analysis was carried out using SPSS version 20.0. RESULTS Eleven patients with testicular cancer were managed during the study period, constituting 0.01% of new cases seen in the hospital. Peak age was 20-29 years (54.55%), with a mean age of 29.27 ± 9.51yrs. The most common presentation was painless scrotal swelling, observed in nine (81.8%) patients. Nine (81.8%) patients presented six months or more after onset of symptoms with advanced disease. Distant metastasis was seen in two (18.2%) patients. Right sided disease was found in seven (63.6%) and left sided disease in four (36.4%). All had radical inguinal orchidectomy. The most common histological diagnosis was seminoma in 8 (72.7%) patients. All the subjects were offered four courses of chemotherapy with bleomycin, etoposide and cisplatin. However, only four (36.4%) completed the chemotherapy. A statistically significant association was observed between the duration of symptoms and the disease stage (P = 0.003), and between number of chemotherapy sessions and survival (P = 0.02). CONCLUSION Testicular cancer was an uncommon condition in the catchment area of the University of Port Harcourt Teaching Hospital, affecting relatively young men. The commonest presenting complaint was painless scrotal swelling. Most patients presented with Stage II disease, with seminoma being the commonest histopathology. All had surgical treatment; adjuvant chemotherapy improved 5-year survival. Public education is necessary to surmount sociocultural barriers to effective management of testicular tumors in our environment.
Collapse
Affiliation(s)
- V. Abhulimen
- Urology Division, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - E. J. Raphael
- Urology Division, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| |
Collapse
|
16
|
Loveday C, Sud A, Litchfield K, Levy M, Holroyd A, Broderick P, Kote-Jarai Z, Dunning AM, Muir K, Peto J, Eeles R, Easton DF, Dudakia D, Orr N, Pashayan N, Reid A, Huddart RA, Houlston RS, Turnbull C. Runs of homozygosity and testicular cancer risk. Andrology 2019; 7:555-564. [PMID: 31310061 DOI: 10.1111/andr.12667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Testicular germ cell tumour (TGCT) is highly heritable but > 50% of the genetic risk remains unexplained. Epidemiological observation of greater relative risk to brothers of men with TGCT compared to sons has long alluded to recessively acting TGCT genetic susceptibility factors, but to date none have been reported. Runs of homozygosity (RoH) are a signature indicating underlying recessively acting alleles and have been associated with increased risk of other cancer types. OBJECTIVE To examine whether RoH are associated with TGCT risk. METHODS We performed a genome-wide RoH analysis using GWAS data from 3206 TGCT cases and 7422 controls uniformly genotyped using the OncoArray platform. RESULTS Global measures of homozygosity were not significantly different between cases and controls, and the frequency of individual consensus RoH was not significantly different between cases and controls, after correction for multiple testing. RoH at three regions, 11p13-11p14.3, 5q14.1-5q22.3 and 13q14.11-13q.14.13, were, however, nominally statistically significant at p < 0.01. Intriguingly, RoH200 at 11p13-11p14.3 encompasses Wilms tumour 1 (WT1), a recognized cancer susceptibility gene with roles in sex determination and developmental transcriptional regulation, processes repeatedly implicated in TGCT aetiology. DISCUSSION AND CONCLUSION Overall, our data do not support a major role in the risk of TGCT for recessively acting alleles acting through homozygosity, as measured by RoH in outbred populations of cases and controls.
Collapse
Affiliation(s)
- C Loveday
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, UK
| | - A Sud
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, UK
| | - K Litchfield
- Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - M Levy
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, UK
| | - A Holroyd
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, UK
| | - P Broderick
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, UK
| | - Z Kote-Jarai
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, UK
| | - A M Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - K Muir
- Division of Health Sciences, Warwick Medical School, Warwick University, Warwick, UK
- Institute of Population Health, University of Manchester, Manchester, UK
| | - J Peto
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - R Eeles
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - D F Easton
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - D Dudakia
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, UK
| | - N Orr
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - N Pashayan
- Department of Applied Health Research, University College London, London, UK
| | - A Reid
- Academic Uro-oncology Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - R A Huddart
- Academic Radiotherapy Unit, Institute of Cancer Research, Sutton, UK
| | - R S Houlston
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, UK
| | - C Turnbull
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, UK
- William Harvey Research Institute, Queen Mary University, London, UK
- Guys and St Thomas' NHS Foundation Trust, London, UK
- Public Health England, National Cancer Registration and Analysis Service, London, UK
| |
Collapse
|
17
|
Abstract
PURPOSE OF REVIEW We aim to give an overview of the epidemiology and treatment trends of testicular germ cell tumors (TGCTs), with an emphasis on recent trends. RECENT FINDINGS The incidence of TGCT appears to be increasing, particularly in developed countries, although the reasons are not well understood. There is evidence of racial differences in predisposition to TGCT, with white men having highest risk and men of African or Asian descent having lower risk. In the United States, the incidence of TGCT among Hispanics appears to be rising most quickly. A recent genomic analysis indicates there is no highly penetrant major TGCT susceptibility gene. Incorporation of multidisciplinary care has led to excellent long-term cure rates; however, access to care and insurance remains barriers in young men. Recent treatment trends have centered on maximizing oncologic outcomes while minimizing long-term morbidity. SUMMARY Emerging population-level data provide critical insight into the evolving demographics of TGCT, which may allow for elucidation of biologic and environmental determinants of TGCT. Further, identification of socioeconomic barriers to excellent clinical outcomes will allow for targeted interventions to patients with unique demographic and socioeconomic considerations. Treatment trend analyses suggest that the field is moving toward minimizing treatment-related morbidity.
Collapse
|
18
|
Moreno-Mendoza D, Casamonti E, Paoli D, Chianese C, Riera-Escamilla A, Giachini C, Fino MG, Cioppi F, Lotti F, Vinci S, Magini A, Ars E, Sanchez-Curbelo J, Ruiz-Castane E, Lenzi A, Lombardo F, Krausz C. gr/gr deletion predisposes to testicular germ cell tumour independently from altered spermatogenesis: results from the largest European study. Eur J Hum Genet 2019; 27:1578-1588. [PMID: 31053779 DOI: 10.1038/s41431-019-0420-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/26/2019] [Accepted: 04/13/2019] [Indexed: 11/09/2022] Open
Abstract
The association between impaired spermatogenesis and TGCT has stimulated research on shared genetic factors. Y chromosome-linked partial AZFc deletions predispose to oligozoospermia and were also studied in TGCT patients with controversial results. In the largest study reporting the association between gr/gr deletion and TGCT, sperm parameters were unknown. Hence, it remains to be established whether this genetic defect truly represents a common genetic link between TGCT and impaired sperm production. Our aim was to explore the role of the following Y chromosome-linked factors in the predisposition to TGCT: (i) gr/gr deletion in subjects with known sperm parameters; (ii) other partial AZFc deletions and, for the first time, the role of partial AZFc duplications; (iii) DAZ gene dosage variation. 497 TGCT patients and 2030 controls from two Mediterranean populations with full semen/andrological characterization were analyzed through a series of molecular genetic techniques. Our most interesting finding concerns the gr/gr deletion and DAZ gene dosage variation (i.e., DAZ copy number is different from the reference sequence), both conferring TGCT susceptibility. In particular, the highest risk was observed when normozoospermic TGCT and normozoospermic controls were compared (OR = 3.7; 95% CI = 1.5-9.1; p = 0.006 for gr/gr deletion and OR = 1.8; 95% CI = 1.1-3.0; p = 0.013 for DAZ gene dosage alteration). We report in the largest European study population the predisposing effect of gr/gr deletion to TGCT as an independent risk factor from impaired spermatogenesis. Our finding implies regular tumour screening/follow-up in male family members of TGCT patients with gr/gr deletion and in infertile gr/gr deletion carriers.
Collapse
Affiliation(s)
- Daniel Moreno-Mendoza
- Andrology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Elena Casamonti
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Centre of Excellence DeNothe, University of Florence, Florence, Italy
| | - Donatella Paoli
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine "Sapienza", University of Rome, Rome, Italy
| | - Chiara Chianese
- Andrology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Antoni Riera-Escamilla
- Andrology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Claudia Giachini
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Centre of Excellence DeNothe, University of Florence, Florence, Italy
| | - Maria Grazia Fino
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Centre of Excellence DeNothe, University of Florence, Florence, Italy
| | - Francesca Cioppi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Centre of Excellence DeNothe, University of Florence, Florence, Italy
| | - Francesco Lotti
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Centre of Excellence DeNothe, University of Florence, Florence, Italy
| | - Serena Vinci
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Centre of Excellence DeNothe, University of Florence, Florence, Italy
| | - Angela Magini
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Centre of Excellence DeNothe, University of Florence, Florence, Italy
| | - Elisabet Ars
- Molecular Biology Laboratory, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josvany Sanchez-Curbelo
- Andrology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Eduard Ruiz-Castane
- Andrology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Andrea Lenzi
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine "Sapienza", University of Rome, Rome, Italy
| | - Francesco Lombardo
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine "Sapienza", University of Rome, Rome, Italy
| | - Csilla Krausz
- Andrology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Barcelona, Spain. .,Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Centre of Excellence DeNothe, University of Florence, Florence, Italy.
| |
Collapse
|
19
|
Family history of cancer and risk of paediatric and young adult's testicular cancer: A Norwegian cohort study. Br J Cancer 2019; 120:1007-1014. [PMID: 30967648 PMCID: PMC6734662 DOI: 10.1038/s41416-019-0445-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/13/2019] [Accepted: 03/13/2019] [Indexed: 12/17/2022] Open
Abstract
Background The aim of this study was to examine the association of a family history of cancer with the risk of testicular cancer in young adults. Methods This is a prospective cohort study including 1,974,287 males born 1951–2015, of whom 2686 were diagnosed with TC before the age of 30. Results A history of TC in male relatives was significantly associated with a diagnosis of TC among children and young adults, including brothers (6.3-fold), sons (4.7-fold), fathers (4.4-fold), paternal uncles (2.0-fold) and maternal uncles (1.9-fold). Individuals with a father diagnosed with a carcinoma or sarcoma showed an elevated risk (1.1-fold and 1.8-fold, respectively). A family history of mesothelioma was positively associated with a risk of TC [(father (2.8-fold), mother (4.6-fold) and maternal uncles and aunt (4.4-fold)]. Elevated risks were also observed when siblings were diagnosed with malignant melanoma (1.4-fold). The risk of TC was also increased when fathers (11.1-fold), paternal (4.9-fold) and maternal uncles and aunts (4.6-fold) were diagnosed with malignant neuroepithelial-tumours. Conclusion We found an increased risk of TC among children and young adults with a family history of TC, carcinoma, mesothelioma, sarcoma, malignant melanoma and malignant neuroepithelial tumours. Hereditary cancer syndromes might underlie some of the associations reported in this study.
Collapse
|
20
|
Lobo J, Gillis AJM, Jerónimo C, Henrique R, Looijenga LHJ. Human Germ Cell Tumors are Developmental Cancers: Impact of Epigenetics on Pathobiology and Clinic. Int J Mol Sci 2019; 20:E258. [PMID: 30634670 PMCID: PMC6359418 DOI: 10.3390/ijms20020258] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 12/25/2018] [Accepted: 01/07/2019] [Indexed: 02/03/2023] Open
Abstract
Current (high throughput omics-based) data support the model that human (malignant) germ cell tumors are not initiated by somatic mutations, but, instead through a defined locked epigenetic status, representative of their cell of origin. This elegantly explains the role of both genetic susceptibility as well as environmental factors in the pathogenesis, referred to as 'genvironment'. Moreover, it could also explain various epidemiological findings, including the rising incidence of this type of cancer in Western societies. In addition, it allows for identification of clinically relevant and informative biomarkers both for diagnosis and follow-up of individual patients. The current status of these findings will be discussed, including the use of high throughput DNA methylation profiling for determination of differentially methylated regions (DMRs) as well as chromosomal copy number variation (CNV). Finally, the potential value of methylation-specific tumor DNA fragments (i.e., XIST promotor) as well as embryonic microRNAs as molecular biomarkers for cancer detection in liquid biopsies will be presented.
Collapse
Affiliation(s)
- João Lobo
- Cancer Biology and Epigenetics Group, Research Center of Portuguese Oncology Institute of Porto (GEBC CI-IPOP), R. Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal.
- Department of Pathology, Portuguese Oncology Institute of Porto (IPOP), R. Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal.
- Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira 228, 4050-513 Porto, Portugal;.
| | - Ad J M Gillis
- Laboratory of Experimental Patho-Oncology (LEPO), Josephine Nefkens Building, Erasmus MC, Department of Pathology, University Medical Center, Cancer Institute, Be-432A, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands.
| | - Carmen Jerónimo
- Cancer Biology and Epigenetics Group, Research Center of Portuguese Oncology Institute of Porto (GEBC CI-IPOP), R. Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal.
- Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira 228, 4050-513 Porto, Portugal;.
| | - Rui Henrique
- Cancer Biology and Epigenetics Group, Research Center of Portuguese Oncology Institute of Porto (GEBC CI-IPOP), R. Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal.
- Department of Pathology, Portuguese Oncology Institute of Porto (IPOP), R. Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal.
- Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira 228, 4050-513 Porto, Portugal;.
| | - Leendert H J Looijenga
- Laboratory of Experimental Patho-Oncology (LEPO), Josephine Nefkens Building, Erasmus MC, Department of Pathology, University Medical Center, Cancer Institute, Be-432A, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands.
| |
Collapse
|
21
|
Nestler T, Schmelz H. Epidemiology, Risk Factors, and Histopathology in Testicular Cancer. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
22
|
Nestler T, Schmelz H. Epidemiology, Risk Factors, and Histopathology in Testicular Cancer. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42603-7_1-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
23
|
Zhang L, Yu H, Hemminki O, Försti A, Sundquist K, Hemminki K. Familial Associations in Testicular Cancer with Other Cancers. Sci Rep 2018; 8:10880. [PMID: 30022029 PMCID: PMC6052159 DOI: 10.1038/s41598-018-28819-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/29/2018] [Indexed: 01/03/2023] Open
Abstract
Familial risks for testicular cancer (TC) are among the highest of all cancers. However, data are limited for histological types of TC and for possible familial associations of TC with other cancers. We used the nationwide Swedish Family-Cancer Database for years 1958 to 2015 to analyse familial relative risks (RR) for 11,138 TC patients when first-degree relatives were diagnosed with TC or other cancer in reference to those without a family history. A total of 191 familial TCs were found, which accounted for 2.0% of all TC. The RR was 5.06 when one family member was diagnosed with TC with no significant difference between seminoma and nonseminoma. However, the risk for nonseminoma was 33.59 when two family members were affected. Internally consistent familial associations of TC, particularly of seminoma, were found with breast and nervous system cancers and melanoma. Individual significant associations were found for a number of sites, including ovarian, endometrial and prostate cancers. Our results suggest that nonseminoma may have a stronger genetic background than seminoma but seminoma shares more familial associations with discordant cancers. Clustering of TC with hormone-dependent cancers of the breast, ovary, endometrium and prostate may suggest mechanistic links and possibly gene-environment interactions.
Collapse
Affiliation(s)
- Luyao Zhang
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany
| | - Hongyao Yu
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany
| | - Otto Hemminki
- Department of Abdominal Surgery and Urology, Helsinki University Hospital, Helsinki, Finland.,Cancer Gene Therapy Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Asta Försti
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany.,Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA.,Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Shimane, Japan
| | - Kari Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany. .,Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden.
| |
Collapse
|
24
|
Markulin D, Vojta A, Samaržija I, Gamulin M, Bečeheli I, Jukić I, Maglov Č, Zoldoš V, Fučić A. Association Between RASSF1A Promoter Methylation and Testicular Germ Cell Tumor: A Meta-analysis and a Cohort Study. Cancer Genomics Proteomics 2018; 14:363-372. [PMID: 28871003 DOI: 10.21873/cgp.20046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/05/2017] [Accepted: 08/08/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The RAS association domain family protein 1a (RASSF1A) is a prominent tumor suppressor gene showing altered promoter methylation in testicular germ cell tumors (TGCT). RASSF1A promoter hypermethylation might represent an early event in TGCT tumorigenesis. We investigated whether the RASSF1A promoter methylation in peripheral blood of TGCT patients can be associated with testicular cancer risk. MATERIALS AND METHODS Following a meta-analysis, we performed a cohort study including 32 testicular cancer patients and 32 healthy controls. Promoter methylation of the RASSF1A and O6-methylguanine-DNA-methyltransferase (MGMT) genes was analyzed using bisulfite pyrosequencing of DNA from peripheral blood. RESULTS Meta-analysis showed an odds ratio (OR) of 7.69 for RASSF1A promoter methylation as a risk factor for TGCT. Cohort study found altered methylation of the RASSF1A promoter in blood of TGCT patients. Methylation was higher in TGCT patients before BEP chemotherapy. CONCLUSION The meta-analysis indicates a role of the RASSF1A promoter hypermethylation from peripheral blood in TCGT. We confirmed that finding in our cohort study, which represents the first report of changed RASSF1A promoter methylation in peripheral blood TGCT.
Collapse
Affiliation(s)
- Dora Markulin
- University of Zagreb, Faculty of Science, Department of Biology, Division of Molecular Biology, Zagreb, Croatia
| | - Aleksandar Vojta
- University of Zagreb, Faculty of Science, Department of Biology, Division of Molecular Biology, Zagreb, Croatia
| | - Ivana Samaržija
- University of Zagreb, Faculty of Science, Department of Biology, Division of Molecular Biology, Zagreb, Croatia
| | - Marija Gamulin
- University Hospital Centre Zagreb, Department of Oncology, Zagreb, Croatia
| | | | - Irena Jukić
- Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - Čedomir Maglov
- Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - Vlatka Zoldoš
- University of Zagreb, Faculty of Science, Department of Biology, Division of Molecular Biology, Zagreb, Croatia
| | - Aleksandra Fučić
- Institute for Medical Research and Occupational Health, Zagreb, Croatia
| |
Collapse
|
25
|
Loveday C, Litchfield K, Levy M, Holroyd A, Broderick P, Kote-Jarai Z, Dunning AM, Muir K, Peto J, Eeles R, Easton DF, Dudakia D, Orr N, Pashayan N, Reid A, Huddart RA, Houlston RS, Turnbull C. Validation of loci at 2q14.2 and 15q21.3 as risk factors for testicular cancer. Oncotarget 2018; 9:12630-12638. [PMID: 29560096 PMCID: PMC5849160 DOI: 10.18632/oncotarget.23117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 11/15/2017] [Indexed: 01/21/2023] Open
Abstract
Testicular germ cell tumor (TGCT), the most common cancer in men aged 18 to 45 years, has a strong heritable basis. Genome-wide association studies (GWAS) have proposed single nucleotide polymorphisms (SNPs) at a number of loci influencing TGCT risk. To further evaluate the association of recently proposed risk SNPs with TGCT at 2q14.2, 3q26.2, 7q36.3, 10q26.13 and 15q21.3, we analyzed genotype data on 3,206 cases and 7,422 controls. Our analysis provides independent replication of the associations for risk SNPs at 2q14.2 (rs2713206 at P = 3.03 × 10-2; P-meta = 3.92 × 10-8; nearest gene, TFCP2L1) and rs12912292 at 15q21.3 (P = 7.96 × 10-11; P-meta = 1.55 × 10-19; nearest gene PRTG). Case-only analyses did not reveal specific associations with TGCT histology. TFCP2L1 joins the growing list of genes located within TGCT risk loci with biologically plausible roles in developmental transcriptional regulation, further highlighting the importance of this phenomenon in TGCT oncogenesis.
Collapse
Affiliation(s)
- Chey Loveday
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Kevin Litchfield
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
- Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - Max Levy
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Amy Holroyd
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Peter Broderick
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Zsofia Kote-Jarai
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Alison M Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Kenneth Muir
- Division of Health Sciences, Warwick Medical School, Warwick University, Warwick, UK
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Julian Peto
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Rosalind Eeles
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Darshna Dudakia
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Nick Orr
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Nora Pashayan
- Department of Applied Health Research, University College London, London, UK
| | - Alison Reid
- Academic Uro-oncology Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Robert A Huddart
- Academic Radiotherapy Unit, Institute of Cancer Research, Sutton, Surrey, UK
| | - Richard S Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Clare Turnbull
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
- William Harvey Research Institute, Queen Mary University, London, UK
- Guys and St Thomas NHS Foundation Trust, London, UK
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| |
Collapse
|
26
|
Adolescent and Young Adult Testicular Germ Cell Tumors: Special Considerations. Adv Urol 2018; 2018:2375176. [PMID: 29662516 PMCID: PMC5832033 DOI: 10.1155/2018/2375176] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/27/2017] [Indexed: 01/13/2023] Open
Abstract
While testicular germ cell tumors (T-GCTs) make up only 0.5% of pediatric malignancies and less than 2% of adult malignancies, they comprise 14% of adolescent malignancies, making it the most common solid tumor in this age group. The transition in incidence at this age is also accompanied by a transition in tumor histology with adolescents having mostly pure embryonal carcinoma and mixed nonseminomatous germ cell tumors. Similar to T-GCTs of all ages, surgical excision with orchiectomy is the standard initial step in treatment. Chemotherapy, retroperitoneal lymph node dissection, and targeted treatment of distant metastases make even widely disseminated disease treatable and curable. For this reason, in many ways, the future focus has expanded beyond survival alone to emphasize quality of life issues such as fertility and hypogonadism. However, adolescents remain the age group least studied or understood as they fall in between the ages included in most study designs. Also, they require the most psychosocial support because of the challenges unique to the adolescent period. In this review, we aim to highlight the known outcome data for T-GCTs in this population and also to discuss the unique aspects of treatment and support for this age group.
Collapse
|
27
|
Poynter JN, Richardson M, Roesler M, Krailo M, Amatruda JF, Frazier AL. Family history of cancer in children and adolescents with germ cell tumours: a report from the Children's Oncology Group. Br J Cancer 2017; 118:121-126. [PMID: 29065103 PMCID: PMC5765220 DOI: 10.1038/bjc.2017.358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 01/07/2023] Open
Abstract
Background: Studies of family history of cancer in paediatric germ cell tumours (GCTs) are few, and none has had sufficient sample size to specifically evaluate family history of GCT. Methods: We utilised family history data from a paediatric GCT study to calculate standardised incidence ratios (SIR) for GCT and other cancers using age- and sex-specific incidence rates from the SEER Program. Results: This analysis included 7998 relatives of paediatric GCT probands. We observed a higher number of GCT cases than expected in male and female relatives of probands (SIR=2.38, 95% CI 1.25, 3.51 for males; SIR=14.3, 95% CI 0.29, 28.4 for females). Further, we observed a particularly strong SIR for relatives of probands with intracranial GCT (SIR=8.07, 95% CI 3.51, 12.6). The SIR for relatives of probands with ovarian GCT was also elevated but did not reach statistical significance (SIR 4.35, 95% CI 0-9.27). Other notable associations include elevated SIRs for melanoma in male relatives and reduced SIRs for lymphatic/haematologic malignancies in male and female relatives. Conclusions: These results support the hypothesis that familial aggregation of GCT occurs in males and females.
Collapse
Affiliation(s)
- Jenny N Poynter
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
| | - Michaela Richardson
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA
| | - Michelle Roesler
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA
| | - Mark Krailo
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 91016, USA
| | - James F Amatruda
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - A Lindsay Frazier
- Dana-Farber/ Boston Children's Cancer and Blood Disorders Center, Boston, MA 02115, USA
| |
Collapse
|
28
|
Litchfield K, Levy M, Orlando G, Loveday C, Law P, Migliorini G, Holroyd A, Broderick P, Karlsson R, Haugen TB, Kristiansen W, Nsengimana J, Fenwick K, Assiotis I, Kote-Jarai ZS, Dunning AM, Muir K, Peto J, Eeles R, Easton DF, Dudakia D, Orr N, Pashayan N, Bishop DT, Reid A, Huddart RA, Shipley J, Grotmol T, Wiklund F, Houlston RS, Turnbull C. Identification of 19 new risk loci and potential regulatory mechanisms influencing susceptibility to testicular germ cell tumor. Nat Genet 2017; 49:1133-1140. [PMID: 28604728 PMCID: PMC6016736 DOI: 10.1038/ng.3896] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/16/2017] [Indexed: 12/29/2022]
Abstract
Genome-wide association studies (GWAS) have transformed understanding of susceptibility to testicular germ cell tumors (TGCTs), but much of the heritability remains unexplained. Here we report a new GWAS, a meta-analysis with previous GWAS and a replication series, totaling 7,319 TGCT cases and 23,082 controls. We identify 19 new TGCT risk loci, roughly doubling the number of known TGCT risk loci to 44. By performing in situ Hi-C in TGCT cells, we provide evidence for a network of physical interactions among all 44 TGCT risk SNPs and candidate causal genes. Our findings implicate widespread disruption of developmental transcriptional regulators as a basis of TGCT susceptibility, consistent with failed primordial germ cell differentiation as an initiating step in oncogenesis. Defective microtubule assembly and dysregulation of KIT-MAPK signaling also feature as recurrently disrupted pathways. Our findings support a polygenic model of risk and provide insight into the biological basis of TGCT.
Collapse
Affiliation(s)
- Kevin Litchfield
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Max Levy
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Giulia Orlando
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Chey Loveday
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Philip Law
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Gabriele Migliorini
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Amy Holroyd
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Peter Broderick
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Robert Karlsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, 171 77, Sweden
| | - Trine B Haugen
- Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Wenche Kristiansen
- Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Jérémie Nsengimana
- Section of Epidemiology & Biostatistics, Leeds Institute of Cancer and Pathology, Leeds, LS9 7TF, UK
| | - Kerry Fenwick
- Tumour Profiling Unit, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Ioannis Assiotis
- Tumour Profiling Unit, The Institute of Cancer Research, London, SM2 5NG, UK
| | - ZSofia Kote-Jarai
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Alison M. Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Kenneth Muir
- Division of Health Sciences, Warwick Medical School, Warwick University, CV4 7AL, UK
- Institute of Population Health, University of Manchester, M1 3BB, UK
| | - Julian Peto
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rosalind Eeles
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, SM2 5NG, UK
- Royal Marsden NHS Foundation Trust, London, SM2 5NG, UK
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, CB1 8RN, UK
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Darshna Dudakia
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Nick Orr
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, 237 Fulham Road, London SW3 6JB, UK
| | - Nora Pashayan
- Department of Applied Health Research, University College London, London, WC1E 6BT, UK
| | | | | | - D. Timothy Bishop
- Section of Epidemiology & Biostatistics, Leeds Institute of Cancer and Pathology, Leeds, LS9 7TF, UK
| | - Alison Reid
- Academic Radiotherapy Unit, Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK
| | - Robert A Huddart
- Academic Radiotherapy Unit, Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK
| | - Janet Shipley
- Division of Molecular Pathology, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Tom Grotmol
- Department of Research, Cancer Registry of Norway, Oslo, 0369, Norway
| | - Fredrik Wiklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, 171 77, Sweden
| | - Richard S Houlston
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Clare Turnbull
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, SM2 5NG, UK
- William Harvey Research Institute, Queen Mary University, London, EC1M 6BQ, UK
| |
Collapse
|
29
|
Ulytė A, Ulys A, Sužiedėlis K, Patašius A, Smailytė G. Testicular cancer in two brothers of a quadruplet: a case report and a review of literature. Acta Med Litu 2017. [PMID: 28630588 PMCID: PMC5467958 DOI: 10.6001/actamedica.v24i1.3458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. Testicular cancer and a multiple birth are both rare events, and the risk of testicular cancer is increased in twins. In Lithuania, only five quadruplets have been recorded since the middle of the 20th century. In this report, we present two rare events in one family: testicular cancer in two brothers of a quadruplet (three brothers and a sister). Case description. Both patients were diagnosed at 21 years of age and died within two years from the diagnosis despite treatment. The third symptomless brother did not have testicular pathology. We also review the risk factors associated with testicular cancer, and the proposed hypotheses how a multiple birth results in an increased risk. The most consistent risk factors for testicular cancer are cryptorchidism, prior history of testicular cancer, and a positive familial history. According to different studies, the risk of testicular cancer in twins is higher from 22% to 30%, compared to the general population. Conclusions. To our knowledge, we have presented the first case of testicular teratoblastoma in brothers of a quadruplet.
Collapse
Affiliation(s)
- Agnė Ulytė
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | | | | | - Giedrė Smailytė
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,National Cancer Institute, Vilnius, Lithuania
| |
Collapse
|
30
|
Litchfield K, Levy M, Dudakia D, Proszek P, Shipley C, Basten S, Rapley E, Bishop DT, Reid A, Huddart R, Broderick P, Castro DGD, O'Connor S, Giles RH, Houlston RS, Turnbull C. Rare disruptive mutations in ciliary function genes contribute to testicular cancer susceptibility. Nat Commun 2016; 7:13840. [PMID: 27996046 PMCID: PMC5187424 DOI: 10.1038/ncomms13840] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 11/04/2016] [Indexed: 12/30/2022] Open
Abstract
Testicular germ cell tumour (TGCT) is the most common cancer in young men. Here we sought to identify risk factors for TGCT by performing whole-exome sequencing on 328 TGCT cases from 153 families, 634 sporadic TGCT cases and 1,644 controls. We search for genes that are recurrently affected by rare variants (minor allele frequency <0.01) with potentially damaging effects and evidence of segregation in families. A total of 8.7% of TGCT families carry rare disruptive mutations in the cilia-microtubule genes (CMG) as compared with 0.5% of controls (P=2.1 × 10-8). The most significantly mutated CMG is DNAAF1 with biallelic inactivation and loss of DNAAF1 expression shown in tumours from carriers. DNAAF1 mutation as a cause of TGCT is supported by a dnaaf1hu255h(+/-) zebrafish model, which has a 94% risk of TGCT. Our data implicate cilia-microtubule inactivation as a cause of TGCT and provide evidence for CMGs as cancer susceptibility genes.
Collapse
Affiliation(s)
- Kevin Litchfield
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SM2 5NG, UK
| | - Max Levy
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SM2 5NG, UK
| | - Darshna Dudakia
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SM2 5NG, UK
| | - Paula Proszek
- Centre for Molecular Pathology, The Royal Marsden NHS Foundation Trust, London SM2 5NG, UK
| | - Claire Shipley
- Centre for Molecular Pathology, The Royal Marsden NHS Foundation Trust, London SM2 5NG, UK
| | - Sander Basten
- Department of Nephrology and Hypertension, Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Uppsalalaan 6, Utrecht 3584CT, The Netherlands
| | - Elizabeth Rapley
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SM2 5NG, UK
| | - D. Timothy Bishop
- Section of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, Leeds LS9 7TF, UK
| | - Alison Reid
- Academic Radiotherapy Unit, The Institute of Cancer Research, London SM2 5NG, UK
| | - Robert Huddart
- Academic Radiotherapy Unit, The Institute of Cancer Research, London SM2 5NG, UK
| | - Peter Broderick
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SM2 5NG, UK
| | - David Gonzalez de Castro
- Centre for Molecular Pathology, The Royal Marsden NHS Foundation Trust, London SM2 5NG, UK
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast BT9 7AE, UK
| | - Simon O'Connor
- Centre for Molecular Pathology, The Royal Marsden NHS Foundation Trust, London SM2 5NG, UK
| | - Rachel H. Giles
- Department of Nephrology and Hypertension, Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Uppsalalaan 6, Utrecht 3584CT, The Netherlands
| | - Richard S. Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SM2 5NG, UK
- Division of Molecular Pathology, The Institute of Cancer Research, London SM2 5NG, UK
| | - Clare Turnbull
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SM2 5NG, UK
- William Harvey Research Institute, Queen Mary University, London EC1M 6BQ, UK
- Department of Clinical Genetics, Guy's and St Thomas' NHS Trust, London SE1 9RS, UK
| |
Collapse
|
31
|
The genomic landscape of testicular germ cell tumours: from susceptibility to treatment. Nat Rev Urol 2016; 13:409-19. [PMID: 27296647 DOI: 10.1038/nrurol.2016.107] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The genomic landscape of testicular germ cell tumour (TGCT) can be summarized using four overarching hypotheses. Firstly, TGCT risk is dominated by inherited genetic factors, which determine nearly half of all disease risk and are highly polygenic in nature. Secondly KIT-KITLG signalling is currently the major pathway that is implicated in TGCT formation, both as a predisposition risk factor and a somatic driver event. Results from genome-wide association studies have also consistently suggested that other closely related pathways involved in male germ cell development and sex determination are associated with TGCT risk. Thirdly, the method of disease formation is unique, with tumours universally stemming from a noninvasive precursor lesion, probably of fetal origin, which lies dormant through childhood into adolescence and then eventually begins malignant growth in early adulthood. Formation of a 12p isochromosome, a hallmark of TGCT observed in nearly all tumours, is likely to be a key triggering event for malignant transformation. Finally, TGCT have been shown to have a distinctive somatic mutational profile, with a low rate of point mutations contrasted with frequent large-scale chromosomal gains. These four hypotheses by no means constitute a complete model that explains TGCT tumorigenesis, but advances in genomic technologies have enabled considerable progress in describing and understanding the disease. Further advancing our understanding of the genomic basis of TGCT offers a clear opportunity for clinical benefit in terms of preventing invasive cancer arising in young men, decreasing the burden of chemotherapy-related survivorship issues and reducing mortality in the minority of patients who have treatment-refractory disease.
Collapse
|
32
|
Abstract
Testicular germ cell tumours are at the crossroads of developmental and neoplastic processes. Their cause has not been fully elucidated but differences in incidences suggest that a combination of genetic and environment factors are involved, with environmental factors predominating early in life. Substantial progress has been made in understanding genetic susceptibility in the past 5 years on the basis of the results of large genome-wide association studies. Testicular germ cell tumours are highly sensitive to radiotherapy and chemotherapy and hence have among the best outcomes of all tumours. Because the tumours occur mainly in young men, preservation of reproductive function, quality of life after treatment, and late effects are crucial concerns. In this Seminar, we provide an overview of advances in the understanding of the epidemiology, genetics, and biology of testicular germ cell tumours. We also summarise the consensus on how to treat testicular germ cell tumours and focus on a few controversies and improvements in the understanding of late effects of treatment and quality of life for survivors.
Collapse
Affiliation(s)
- Ewa Rajpert-De Meyts
- Department of Growth and Reproduction, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disrupting Effects on Male Reproduction and Child Health, Copenhagen, Denmark
| | - Katherine A McGlynn
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Keisei Okamoto
- Department of Urology, Shiga University of Medical Science, Tsukinowa, Seta, Shiga, Japan.
| | - Michael A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Carsten Bokemeyer
- Department of Oncology, Haematology, Bone Marrow Transplantation with section Pneumology, Department of Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
33
|
Rovito MJ, Manjelievskaia J, Leone JE, Lutz MJ, Nangia A. From 'D' to 'I': A critique of the current United States preventive services task force recommendation for testicular cancer screening. Prev Med Rep 2016; 3:361-6. [PMID: 27419037 PMCID: PMC4929233 DOI: 10.1016/j.pmedr.2016.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 04/20/2016] [Indexed: 12/02/2022] Open
Abstract
In 2004, the United States Preventive Services Task Force (USPSTF) gave testicular cancer (TCa) screening a ‘D’ recommendation, discouraging the use of this preventive service. The USPSTF suggested that screening, inclusive of testicular self-examination (TSE) and clinician examination, does not reduce TCa mortality rates and that the high risk of false positives could serve as a detriment to patient quality of life. Others suggests that TCa screening is ineffective at detecting early-stage cases of TCa and readily highlights a lack of empirical evidence demonstrating said efficacy. These assertions, however, stand in stark contrast to the widely held support of TCa screening among practicing public health professionals, advocacy groups, and clinicians. In this present study, a review was conducted of the methods and processes used by the USPSTF in their 2011 reaffirmation of the ‘D’ grade recommendation. The evidence base and commentary offered as to why TSE, as part of the overall recommendation for TCa screening, was given a ‘D’ grade were analyzed for logical reasoning and methodological rigor. Considering the methodological flaws and the veritable lack of evidence needed to grant a conclusive recommendation, the question is raised if the current ‘D’ grade for TCa screening (i.e. discourage the use of said service) should be changed to an ‘I’ statement (i.e. the balance of benefits and harms is indeterminate). Therefore the purpose of this paper is to present the evidence of TCa screening in the context of efficacy and prevention in order for the field to reassess its relative value. The USPSTF gave testicular cancer screening a ‘D’ rating, discouraging its practice. We discover methodological flaws and a lack of evidence needed to grant a D rating. The D rating contrasts with the widely held support of TCa screening among practitioners. The question is raised if the ‘D’ rating for TCa screening should be changed to an ‘I′ statement.
Collapse
Affiliation(s)
- Michael J Rovito
- College of Health and Public Affairs, Department of Health Professions, University of Central Florida, 12805 Pegasus Drive, HPA1 Room 269, Orlando, FL 32828, United States
| | - Janna Manjelievskaia
- Mayes College of Healthcare Business and Policy, Department of Health Policy and Public Health, University of the Sciences in Philadelphia, 600 S 43rd St, Philadelphia, PA 19104, United States
| | - James E Leone
- Department of Movement Arts, Health Promotion, and Leisure Studies, Bridgewater State University, Bridgewater, MA 02325, United States
| | - Michael J Lutz
- Michigan Institute of Urology, 6900 Orchard Lake Rd. West Bloomfield, MI 48322, United States
| | - Ajay Nangia
- Dept. of Urology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, United States
| |
Collapse
|
34
|
Resnick MJ. Translating Testicular Cancer Epidemiology into Clinical Practice. Eur Urol 2015; 68:290-1. [DOI: 10.1016/j.eururo.2015.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 01/14/2015] [Indexed: 10/23/2022]
|