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Rezaee ME, Elias R, Li HL, Agrawal P, Pallauf M, Enikeev D, Ged Y, Eggener S, Singla N. Survival outcomes and molecular drivers of testicular cancer in hispanic men. Urol Oncol 2024:S1078-1439(24)00444-7. [PMID: 38821727 DOI: 10.1016/j.urolonc.2024.04.024] [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: 11/20/2023] [Revised: 03/04/2024] [Accepted: 04/26/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVE To examine survival outcomes and molecular drivers in testis cancer among Hispanic men using a large national sample and molecular database. METHODS We reviewed the SEER registry for testicular cancer from 2000 to 2020. Cox proportional hazards models were used to examine the relationship between race/ethnicity and cancer-specific survival (CSS) by tumor type (seminoma vs. nonseminomatous germ cell tumors [NSGCT]). All models were adjusted for demographic, socioeconomic, and treatment variables. We accessed somatic mutations for testicular cancers through AACR Project GENIE v13.1 and compared mutational frequencies by ethnicity. RESULTS Our cohort consisted of 43,709 patients (23.3% Hispanic) with median follow-up 106 months (interquartile range: 45-172). Compared to Non-Hispanic Whites (NWH), Hispanics presented at a younger age but with more advanced disease. Hispanics experienced worse CSS for NSGCT (HR 1.7, 95% CI: 1.5-2.0, P < 0.01) but not seminoma. Somatic mutation data was available for 699 patients. KIT and KRAS mutations occurred in 24.2% and 16.9% of seminoma patients (n = 178), respectively. TP53 and KRAS mutations occurred in 12.1% and 7.9% of NSGCT patients (n = 521), respectively. No differences in mutational frequencies were observed between ethnic groups. There was significant heterogeneity in primary ancestral group for Hispanic patients with available data (n = 53); 14 (26.4%) patients had primary Native American ancestry and 30 (56.6%) had primary European ancestry. CONCLUSIONS Cancer-specific survival is worse for Hispanic men with non-seminoma of the testicle. Somatic mutation analysis suggests no differences by ethnicity, though genetic ancestry is heterogeneous among patients identifying as Hispanic.
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Affiliation(s)
- Michael E Rezaee
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Roy Elias
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Howard L Li
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pranjal Agrawal
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Maximilian Pallauf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Urology, University of Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Yasser Ged
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Nirmish Singla
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD.
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Schafer EJ, Jemal A, Wiese D, Sung H, Kratzer TB, Islami F, Dahut WL, Knudsen KE. Disparities and Trends in Genitourinary Cancer Incidence and Mortality in the USA. Eur Urol 2023; 84:117-126. [PMID: 36566154 DOI: 10.1016/j.eururo.2022.11.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/14/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Previous studies have reported on incidence and mortality patterns for individual genitourinary cancers in the USA. However, these studies addressed individual cancer types rather than genitourinary cancers overall. OBJECTIVE To comprehensively examine disparities and trends in the incidence and mortality for the four major genitourinary cancers (bladder, kidney, prostate, and testis) in the USA. DESIGN, SETTING, AND PARTICIPANTS We obtained incidence data from the National Cancer Institute 22-registry Surveillance, Epidemiology and End Results (SEER) database and the US Cancer Statistics database (Centers for Disease Control and Prevention) and mortality data from the National Center for Health Statistics to examine cross-sectional and temporal trends in incidence and death rates stratified by sex, race/ethnicity, and county. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Age-adjusted incidence and death rates were calculated using SEER*Stat software. Temporal trends were analyzed using Joinpoint regression for a two-sided significance level of p < 0.05. RESULTS AND LIMITATIONS Incidence and mortality rates for bladder and kidney cancers were two to four times higher for men than for women. Among non-Hispanic White individuals, the highest incidence rates were found in the Northeast for bladder cancer and in Appalachia for kidney cancer, whereas the highest death rates for prostate cancer were found in the West. Incidence rates increased for cancers of the kidney and testis and for advanced-stage prostate cancer in almost all racial/ethnic populations and for bladder cancer in the American Indian/Alaska Native population. Death rates increased for testicular cancer in the Hispanic population and stabilized for prostate cancer among White and Asian American/Pacific Islander men after a steady decline since the early 1990s. Study limitations include misclassification of race/ethnicity on medical records and death certificates. CONCLUSIONS We found persistent sociodemographic disparities and unfavorable trends in incidence or mortality for all four major genitourinary cancers. Future studies should elucidate the reasons for these patterns. PATIENT SUMMARY In the USA, rates of cancer cases are increasing for kidney, testis, and advanced-stage prostate cancers in the overall population, and for bladder cancer in the American Indian/Alaska Native population. Differences in the rates by sex and race/ethnicity remain.
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Affiliation(s)
- Elizabeth J Schafer
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - Ahmedin Jemal
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, GA, USA.
| | - Daniel Wiese
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - Hyuna Sung
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - Tyler B Kratzer
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - Farhad Islami
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - William L Dahut
- Office of the Chief Scientific Officer, American Cancer Society, Atlanta, GA, USA
| | - Karen E Knudsen
- Office of the Chief Executive Officer, American Cancer Society, Atlanta, GA, USA
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Dieckmann KP, Isbarn H, Grobelny F, Dumlupinar C, Utschig J, Wülfing C, Pichlmeier U, Belge G. Testicular Neoplasms: Primary Tumour Size Is Closely Interrelated with Histology, Clinical Staging, and Tumour Marker Expression Rates-A Comprehensive Statistical Analysis. Cancers (Basel) 2022; 14:cancers14215447. [PMID: 36358866 PMCID: PMC9653836 DOI: 10.3390/cancers14215447] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
The role of primary tumour size (TS) in the clinical course of testicular tumours is incompletely understood. We retrospectively evaluated 641 consecutive patients with testicular neoplasms with regard to TS, histology, clinical stage (CS), serum tumour marker (STM) expression and patient age using descriptive statistical methods. TS ≤ 10 mm was encountered in 13.6% of cases. Median TS of 10 mm, 30 mm, 35 mm, and 53 mm were found in benign tumours, seminomas, nonseminomas, and other malignant tumours, respectively. In cases with TS ≤ 10 mm, 50.6% had benign tumours. Upon receiver operating characteristics analysis, TS of > 16 mm revealed 81.5% sensitivity and 81.0% specificity for detecting malignancy. In subcentimeter germ cell tumours (GCTs), 97.7% of cases had CS1, and CS1 frequency dropped with increasing TS. Expression rates of all STMs significantly increased with TS. MicroRNA-371a-3p (M371) serum levels had higher expression rates than classical STMs, with a rate of 44.1% in subcentimeter GCTs. In all, TS is a biologically relevant factor owing to its significant associations with CS, STM expression rates and histology. Importantly, 50% of subcentimeter testicular neoplasms are of benign nature, and M371 outperforms the classical markers even in subcentimeter tumours.
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Affiliation(s)
| | - Hendrik Isbarn
- Martini Klinik, Universitätsklinikum Eppendorf, Martinistrasse 52, D-20251 Hamburg, Germany
| | - Francesca Grobelny
- Tumour Genetics Department, Faculty of Biology and Chemistry, Tumour Genetics, University of Bremen, Leobener Strasse 2/FVG, 28359 Bremen, Germany
| | - Cansu Dumlupinar
- Tumour Genetics Department, Faculty of Biology and Chemistry, Tumour Genetics, University of Bremen, Leobener Strasse 2/FVG, 28359 Bremen, Germany
| | - Julia Utschig
- Department of Urology, Asklepios Klinik Altona, D-22763 Hamburg, Germany
| | - Christian Wülfing
- Department of Urology, Asklepios Klinik Altona, D-22763 Hamburg, Germany
| | - Uwe Pichlmeier
- Institute of Medical Biometry und Epidemiology, Universitätsklinikum Eppendorf, Martinistrasse 52, D-20251 Hamburg, Germany
| | - Gazanfer Belge
- Tumour Genetics Department, Faculty of Biology and Chemistry, Tumour Genetics, University of Bremen, Leobener Strasse 2/FVG, 28359 Bremen, Germany
- Correspondence: ; Tel.: +49-421-218-615-70
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4
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Ahn JJ, Garrison MM, Merguerian PA, Shnorhavorian M. Racial and ethnic disparities in the timing of orchiopexy for cryptorchidism. J Pediatr Urol 2022; 18:696.e1-696.e6. [PMID: 36175288 PMCID: PMC9771941 DOI: 10.1016/j.jpurol.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/12/2022] [Accepted: 09/07/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Many children do not undergo surgery for cryptorchidism in a timely fashion, increasing risk of infertility and malignancy. Racial and ethnic disparities in surgery timing has been suggested in other specialties, but has not been well-explored in Pediatric Urology. OBJECTIVES Our aim was to investigate the association of race and ethnicity with age at orchiopexy. MATERIALS AND METHODS We performed a retrospective cohort study of individuals <18 years of age as captured in the NSQIPP PUF from 2012 to 2016. Those with cancer were excluded. The primary outcome of interest was age at time of surgery. Secondary outcome was the proportion of individuals undergoing surgery by recommended age. Generalized linear models and logistic regression models were created for the outcomes of interest. RESULTS The median age at orchiopexy was 17.4 months (10.7, 43.0) and overall, 51% of subjects underwent orchiopexy by 18 months of age. Non-Hispanic white individuals were most likely to have undergone orchiopexy by 18 months of age, at 56%, compared with only 44% of non-Hispanic black individuals (p < 0.001). When adjusting for co-morbidities and developmental delay, Hispanic patients underwent orchiopexy 5 months later than white patients, on average, and black patients had a delay of 7 months compared to white patients. DISCUSSION These data suggest that orchiopexy is happening at younger ages compared to prior large-scale studies. However, minority patients are on average older at time of orchiopexy, potentially increasing future risk of infertility or malignancy. While an estimated average delay of 5-7 months may not seem high, studies suggest there is an appreciable change in risk with a 6-month delay. Patient, provider, and system-level factors likely all contribute, and these need to be further elucidated. CONCLUSIONS Many racial and ethnic minorities with cryptorchidism have later orchiopexies, and are more likely to have surgery outside the recommended timeframe. Further investigation is warranted to determine the factors contributing to these disparities.
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Affiliation(s)
- Jennifer J Ahn
- University of Washington, Department of Urology, USA; Seattle Children's Hospital, Division of Pediatric Urology, USA.
| | - Michelle M Garrison
- University of Washington School of Public Health, Department of Health Services, USA
| | - Paul A Merguerian
- University of Washington, Department of Urology, USA; Seattle Children's Hospital, Division of Pediatric Urology, USA
| | - Margarett Shnorhavorian
- University of Washington, Department of Urology, USA; Seattle Children's Hospital, Division of Pediatric Urology, USA
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5
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Howard JM, Patel A, Bagrodia A. Reply. Urology 2021; 163:126-131. [PMID: 34343562 DOI: 10.1016/j.urology.2021.05.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/05/2021] [Accepted: 05/03/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare pre-orchiectomy sperm cryopreservation use in testicular cancer patients at a private tertiary care academic center and an affiliated public safety-net hospital. METHODS This was a retrospective cohort study of patients who underwent radical orchiectomy for testicular cancer at a private tertiary-care hospital, which cared primarily for patients with private health insurance, and at a public "safety-net" facility, which cared for patients regardless of insurance status. Clinical and demographic predictors of cryopreservation use prior to orchiectomy were determined by chart review. RESULTS A total of 201 patients formed the study cohort, 106 (53%) at the safety-net hospital and 95 (47%) at the private hospital. Safety net patients were more likely to be non-White (82% vs 15%, p < 0.001), uninsured (80% vs 12%, p < 0.001), Spanish speaking (38% vs 5.6%, p < 0.001), and to reside in areas in the bottom quartile of income (41% vs 5.6%, p < 0.001). On multivariable analysis, treatment at the private tertiary care center was strongly associated with use of cryopreservation (OR 5.60, 95% CI 1.74 - 20.4, p = 0.005, though the effects of specific demographic factors could not be elucidated due to collinearity. CONCLUSIONS Among patients with testicular cancer, disparities exist in use of sperm cryopreservation between the private and safety-net settings. Barriers to the use of cryopreservation in the safety-net population should be sought and addressed.
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Affiliation(s)
- Jeffrey M Howard
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Akshat Patel
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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Funt SA, McHugh DJ, Tsai S, Knezevic A, O'Donnell D, Patil S, Silber D, Bromberg M, Carousso M, Reuter VE, Carver BS, Sheinfeld J, Motzer RJ, Bajorin DF, Bosl GJ, Feldman DR. Four Cycles of Etoposide plus Cisplatin for Patients with Good-Risk Advanced Germ Cell Tumors. Oncologist 2021; 26:483-491. [PMID: 33586274 PMCID: PMC8176973 DOI: 10.1002/onco.13719] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/05/2021] [Indexed: 01/08/2023] Open
Abstract
Background The National Comprehensive Cancer Network recommends either three cycles of bleomycin, etoposide, and cisplatin or four cycles of etoposide and cisplatin (EPx4) as initial chemotherapy for the treatment of good‐risk germ cell tumors (GCTs). To assess the response, toxicity, and survival outcomes of EPx4, we analyzed our experience. Material and Methods Response and survival outcomes, selected toxicities, and adherence to chemotherapy dose and schedule were assessed in patients with good‐risk GCT who received EPx4 at Memorial Sloan Kettering Cancer Center between 1982 and 2016. The results were compared with our past results and published data. Results Between 1982 and 2016, 944 patients with GCT were treated with EPx4, 289 who were previously reported plus 655 treated between January 2000 and August 2016. A favorable response was achieved in 928 of 944 patients (98.3%). Five‐year progression‐free, disease‐specific, and overall survival rates were 93.9%, 98.6%, and 97.9%, respectively. Median follow‐up was 7.3 years (range, 2.8 months to 35.5 years). Viable, nonteratomatous malignant GCT was present in 3.5% of 432 postchemotherapy retroperitoneal lymph node dissection specimens from patients with nonseminomatous GCT. Febrile neutropenia and thromboembolic events occurred in 16.0% and 8.9%, respectively, with one treatment‐related death. In the more recent 655‐patient cohort, full‐dose EPx4 was administered to 631 (96.3%), with deviations from planned treatment driven mainly by vascular (n = 13), hematologic (n = 11), renal (n = 7), or infectious (n = 5) events. Conclusion EPx4 is highly effective and well tolerated in patients with good‐risk GCTs and remains a standard of care. Implications for Practice Four cycles of etoposide and cisplatin (EPx4) is a standard‐of‐care regimen for all patients with good‐risk germ cell tumors with a favorable response rate and disease‐specific survival of 98%. Full‐dose administration of etoposide and cisplatin and complete resection of residual disease lead to optimal outcomes. EPx4 should be the recommended regimen in active smokers, patients with reduced or borderline kidney function, and patients aged 50 years or older, which are patient groups at increased risk for bleomycin pulmonary toxicity. Because of a risk of acquired severe pulmonary illness, EPx4 may also be favored for patients who vape or use e‐cigarettes and during ongoing transmission of severe acute respiratory syndrome coronavirus 2. The NCCN recommends either three cycles of bleomycin, etoposide, and cisplatin (BEPx3) or four cycles of etoposide and cisplatin (EPx4) as initial chemotherapy for the treatment of good‐risk germ cell tumors. This article assesses outcomes specific to EPx4 treatment.
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Affiliation(s)
- Samuel A Funt
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Deaglan J McHugh
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Stephanie Tsai
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Andrea Knezevic
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Devon O'Donnell
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Sujata Patil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Deborah Silber
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Maria Bromberg
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Maryann Carousso
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Brett S Carver
- Department of Urology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Joel Sheinfeld
- Department of Urology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Robert J Motzer
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Dean F Bajorin
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - George J Bosl
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Darren R Feldman
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
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Huang MM, Cheaib JG, Su ZT, Biles MJ, Sharma R, Zhang A, Singla N, Bass EB, Pierorazio PM. Assessing quality of care in the diagnosis and treatment of early-stage testicular cancer: A critical review and summary. Urol Oncol 2021; 39:400-408. [PMID: 33642227 DOI: 10.1016/j.urolonc.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/18/2021] [Accepted: 02/01/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review the current literature on quality of care in the diagnosis and management of early-stage testicular cancer. METHODS PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies on quality of care in testicular cancer diagnosis and management from January 1980 to August 2018. Major overlapping themes related to quality of care in the diagnosis and management of TGCT were identified and evidence related to these themes were abstracted. EVIDENCE 62 studies were included in the review. A number of themes were identified including (1) trends in survival and outcomes, (2) management patterns, (3) adherence to evidence-based clinical guidelines, (4) delays in care, (5) treatment complications and toxicities, (6) sociodemographic factors, (7) volume of patients treated, (8) gaps in provider knowledge and medical errors, and (9) multidisciplinary approaches to care. EVIDENCE SUMMARY As survival for patients with testicular cancer improves, there has been a greater emphasis on other components of quality of care, such as reducing treatment toxicity and minimizing delays in diagnosis. Efforts to meet these goals include encouragement of adherence to evidence-based guidelines, greater utilization of surveillance, and promotion of multidisciplinary team-based care. Although outcomes have improved, social determinants of health, such as insurance status, race, and geographical residence all may influence survival and cancer-related outcomes. Additionally, qualitative review indicates patients who receive care at high-volume institutions appear to experience better outcomes than those treated at smaller centers. CONCLUSIONS As outcomes and survival improve for patients with testicular cancer, quality of care has become an important consideration. Future avenues of research on this topic include identifying an appropriate balance between centralization of care and expanding access to underserved areas, minimizing delays in care, ensuring greater adherence to clinical guidelines, and addressing sociodemographic and racial disparities in outcomes.
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Affiliation(s)
- Mitchell M Huang
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph G Cheaib
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Zhuo T Su
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael J Biles
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ritu Sharma
- The Johns Hopkins Evidence-Based Practice Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Allen Zhang
- The Johns Hopkins Evidence-Based Practice Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Nirmish Singla
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eric B Bass
- The Johns Hopkins Evidence-Based Practice Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
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8
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Kojo K, Kawai K, Kawahara T, Kimura T, Kandori S, Nagumo Y, Nitta S, Kojima T, Okuyama A, Higashi T, Nishiyama H. Recent malignant testicular tumor trend in Japan, a country with an aging population: a large-scale study of 2012-2015 hospital-based cancer registry data. Jpn J Clin Oncol 2020; 50:1201-1208. [PMID: 32627833 DOI: 10.1093/jjco/hyaa110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/05/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Japan's national database of hospital-based cancer registries is estimated to cover ~67% of all new cancer cases. Using this database, we analyzed the characteristics of the recently diagnosed testicular malignancy. METHODS We obtained data for 6510 adult testicular malignancy patients diagnosed in 2012-2015. The distributions of patient ages, histological diagnoses and testicular germ cell tumor hospital care volumes were determined. RESULTS The most common histology was seminoma (60.3% of all testicular malignancies), followed by non-seminoma (24.1%) and diffuse large B-cell lymphoma (13.1%). The median and mean ages of the testicular germ cell tumor patients were high at 38 and 39.8 years, respectively. The age distribution peaked at 30-40 years, followed by 40-50 years. Approximately 18% of testicular germ cell tumor patients were ≥50 years. The ages of the diffuse large B-cell lymphoma patients peaked at 70-80 years (mean 67.7 years). When the analysis was limited to the testicular germ cell tumor patients who received first-course cancer treatment at the participating hospitals, the number of high-volume hospitals with ≥20 testicular germ cell tumor care volume was limited to 61 (10.0% of the 605 hospitals that treated ≥1 testicular germ cell tumor patient). However, when the patients who changed hospitals during treatment or relapsed after treatment completion were analyzed together, the number of high-volume hospitals increased to 104 (17.0% of 612 hospitals). CONCLUSION The testicular germ cell tumor patients' mean age was nearly 40 years. The proportions of older testicular germ cell tumor patients and diffuse large B-cell lymphoma patients were higher than previously thought. The reasons for this trend are unknown, but it is important to address the trend identified herein in a country with a super-aging population.
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Affiliation(s)
- Kosuke Kojo
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Koji Kawai
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of Urology, International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Takashi Kawahara
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomokazu Kimura
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shuya Kandori
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshiyuki Nagumo
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Satoshi Nitta
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takahiro Kojima
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ayako Okuyama
- Center for Cancer Control and Information Services, National Cancer Center Japan, Tokyo, Japan
| | - Takahiro Higashi
- Center for Cancer Control and Information Services, National Cancer Center Japan, Tokyo, Japan
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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9
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Landero-Huerta DA, Vigueras-Villaseñor RM, Yokoyama-Rebollar E, García-Andrade F, Rojas-Castañeda JC, Herrera-Montalvo LA, Díaz-Chávez J, Pérez-Añorve IX, Aréchaga-Ocampo E, Chávez-Saldaña MD. Cryptorchidism and Testicular Tumor: Comprehensive Analysis of Common Clinical Features and Search of SNVs in the KIT and AR Genes. Front Cell Dev Biol 2020; 8:762. [PMID: 32850863 PMCID: PMC7426638 DOI: 10.3389/fcell.2020.00762] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/21/2020] [Indexed: 11/17/2022] Open
Abstract
Allelic variants in genes implicated in the development of testicular germ cell tumor (TGCT) could be present in patients with cryptorchidism (CO). Currently; the mechanisms explaining this relationship are still unknown. In this study the common clinical features in patients with CO and TGCT and 6 variants of KIT and AR genes associated to TGCT were analyzed. Population analyzed included 328 individuals: 91 patients with CO; 79 with TGCT, 13 of them with previous CO diagnosis, and 158 healthy males. Of the 13 patients with TGCT and history of CO, one patient (7.7%) presented the heterozygous form of the variant rs121913507 and two patients (15.4%) presented homozygote genotype for the variant rs121913506 in KIT gene. Interestingly, the heterozygous form for the variant rs121913506 of KIT gene was identifying in all of 13 patients. The rs201934623, rs774171864, and rs12014709 variants of the AR gene did not show any clinical association. Our results strongly support that genetic component in CO could be conditioning for the development of TGCT. Notably, KIT gene variants might be determinants in the pathological association between TGCT and CO.
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Affiliation(s)
- Daniel Adrian Landero-Huerta
- Laboratorio de Biología de la Reproducción, Instituto Nacional de Pediatría, Mexico City, Mexico.,Posgrado en Ciencias Naturales e Ingeniería, Unidad Cuajimalpa, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | | | | | - Fabiola García-Andrade
- Laboratorio de Biología de la Reproducción, Instituto Nacional de Pediatría, Mexico City, Mexico
| | | | - Luis Alonso Herrera-Montalvo
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Instituto Nacional de Medicina Genómica, Mexico City, Mexico
| | | | - Isidro Xavier Pérez-Añorve
- Posgrado en Ciencias Naturales e Ingeniería, Unidad Cuajimalpa, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | - Elena Aréchaga-Ocampo
- Departamento de Ciencias Naturales, Unidad Cuajimalpa, Universidad Autónoma Metropolitana, Mexico City, Mexico
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10
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Chertack N, Ghandour RA, Singla N, Freifeld Y, Hutchinson RC, Courtney K, Bowman IA, Arafat W, Meng X, Moore JA, Aydin AM, Sagalowsky AI, Margulis V, Lotan Y, Woldu SL, Bagrodia A. Overcoming sociodemographic factors in the care of patients with testicular cancer at a safety net hospital. Cancer 2020; 126:4362-4370. [DOI: 10.1002/cncr.33076] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/02/2020] [Accepted: 05/30/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Nathan Chertack
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas
| | - Rashed A. Ghandour
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas
| | - Nirmish Singla
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas
| | - Yuval Freifeld
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas
| | - Ryan C. Hutchinson
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas
| | - Kevin Courtney
- Division of Hematology and Oncology Department of Medicine University of Texas Southwestern Medical Center Dallas Texas
| | - I. Alex Bowman
- Division of Hematology and Oncology Department of Medicine University of Texas Southwestern Medical Center Dallas Texas
| | - Waddah Arafat
- Division of Hematology and Oncology Department of Medicine University of Texas Southwestern Medical Center Dallas Texas
| | - Xiaosong Meng
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas
| | - Joseph A. Moore
- Division of Hematology and Oncology Department of Medicine University of Texas Southwestern Medical Center Dallas Texas
| | - Ahmet M. Aydin
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas
| | - Arthur I. Sagalowsky
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas
| | - Vitaly Margulis
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas
| | - Yair Lotan
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas
| | - Solomon L. Woldu
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas
| | - Aditya Bagrodia
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas
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11
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DeRouen MC, McKinley M, Shah SA, Borno HT, Aoki R, Lichtensztajn DY, Leppert JT, Brooks JD, Chung BI, Gomez SL, Cheng I. Testicular cancer in Hispanics: incidence of subtypes over time according to neighborhood sociodemographic factors in California. Cancer Causes Control 2020; 31:713-721. [PMID: 32440828 DOI: 10.1007/s10552-020-01311-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 05/04/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE Hispanic men in the USA experience the second-highest incidence rate of testicular germ cell tumors (TGCTs), behind non-Hispanic (NH) White men, and have experienced steep increases in TGCT in recent decades. It is unknown whether increases in incidence differ according to neighborhood sociodemographic factors. METHODS We conducted a population-based study of n = 3759 Hispanic and n = 8469 NH White men (n = 12,228 total) diagnosed with TGCT in California during the three most recent pericensal periods. We calculated incidence rates according to neighborhood socioeconomic status (nSES) and among Hispanics, according to ethnic enclave. We calculated incidence rate ratios to compare rates across nSES and ethnic enclave and to examine changes in rates over pericensal time periods according to these neighborhood factors for major histologic types (i.e., seminoma and nonseminoma). RESULTS Hispanic men residing in high SES, compared to low SES, neighborhoods had greater incidence of seminoma and nonseminoma testicular cancer across pericensal periods, as did Hispanic men in low enclave (less ethnic), compared to high enclave, neighborhoods. Between the periods 1998-2002 and 2008-2012, Hispanic men residing in low SES neighborhoods experienced a 39% increased incidence of seminoma, while those residing in low and middle SES neighborhoods experienced 87% and 48% increased incidence of nonseminoma, respectively. CONCLUSION While TGCT incidence has increased among all Hispanic men, incidence increases appear to be driven disproportionately by those residing in lower SES and lower enclave neighborhoods, particularly for nonseminoma.
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Affiliation(s)
- Mindy C DeRouen
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA. .,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA. .,, 2nd Floor, 550 16th St, Stanford, CA, 94158, USA.
| | - Meg McKinley
- Greater Bay Area Cancer Registry, San Francisco, CA, USA
| | - Sumit Anil Shah
- Division of Oncology, Department of Medicine, Stanford School of Medicine, Stanford, CA, USA.,Stanford Cancer Institute, Stanford, CA, USA
| | - Hala T Borno
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.,Division of Hematology/Oncology, Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Rhonda Aoki
- Department of Health Research and Policy, Stanford School of Medicine, Stanford, CA, USA
| | - Daphne Y Lichtensztajn
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.,Greater Bay Area Cancer Registry, San Francisco, CA, USA
| | - John T Leppert
- Stanford Cancer Institute, Stanford, CA, USA.,Division of Urology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Urology, Stanford School of Medicine, Stanford, CA, USA
| | - James D Brooks
- Stanford Cancer Institute, Stanford, CA, USA.,Department of Urology, Stanford School of Medicine, Stanford, CA, USA
| | - Benjamin I Chung
- Stanford Cancer Institute, Stanford, CA, USA.,Department of Urology, Stanford School of Medicine, Stanford, CA, USA
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.,Greater Bay Area Cancer Registry, San Francisco, CA, USA
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.,Greater Bay Area Cancer Registry, San Francisco, CA, USA
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12
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Aydin AM, Zemp L, Cheriyan SK, Sexton WJ, Johnstone PAS. Contemporary management of early stage testicular seminoma. Transl Androl Urol 2020; 9:S36-S44. [PMID: 32055484 PMCID: PMC6995845 DOI: 10.21037/tau.2019.09.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/26/2019] [Indexed: 12/28/2022] Open
Abstract
Therapy for early stage testicular seminoma has changed radically over the past several decades. Given high cure rates and clinical trials supporting less active therapy in most cases, close observation after radical orchiectomy is now considered standard of care for clinical stage (CS) IA/IB seminoma, with either radiation therapy (RT) or chemotherapy salvage options possible. For CS IIA/IIB seminoma characterized by non-bulky retroperitoneal lymph node involvement (≤5 cm in greatest dimension), RT or combination chemotherapy are the standard of care. Given high comparable survival rates, preventing treatment-related toxicity and second malignancy, and limiting quality of life deficits associated with intense treatment has gained much greater importance. Clinical trials are currently testing the feasibility of retroperitoneal lymph node dissection (RPLND) for low volume CS IIA/IIB metastatic testicular seminoma to this end. Likewise, one cycle of chemotherapy is being evaluated as an adjuvant approach to reduce recurrence rates in CS I disease with unfavorable risk factors. Moreover, recent genomic and molecular studies have recently identified novel signatures and a potential biomarker for testicular seminoma. In this review, we first summarize the evolution of early stage seminoma management and discuss the effectiveness and drawbacks of contemporary treatment strategies. We further outline future perspectives and potential challenges in management of early stage testicular seminoma.
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Affiliation(s)
- Ahmet Murat Aydin
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Logan Zemp
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Salim K. Cheriyan
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Wade J. Sexton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Peter A. S. Johnstone
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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13
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Ghandour R, Ashbrook C, Freifeld Y, Singla N, El-Asmar JM, Lotan Y, Margulis V, Eggener S, Woldu S, Bagrodia A. Nationwide Patterns of Care for Stage II Nonseminomatous Germ Cell Tumor of the Testicle. Eur Urol Oncol 2019; 3:198-206. [PMID: 31272940 DOI: 10.1016/j.euo.2019.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/20/2019] [Accepted: 06/11/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Management strategies for advanced testicular cancer published from a few, high-volume clinical centers may not be generalizable. OBJECTIVE To discern treatment patterns for stage II nonseminomatous germ cell tumor (NSGCT) in a nationwide cancer registry. DESIGN, SETTING, AND PARTICIPANTS The National Cancer Database was queried for patients with a stage II NSGCT from 2004 to 2014. Patients were stratified by clinical nodal status: cN1/stage IIA, cN2/stage IIB, and cN3/stage IIIC. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS Logistic regression was performed to determine factors independently associated with primary retroperitoneal lymph node dissection (RPLND), primary chemotherapy, and postchemotherapy RPLND (PC-RPLND). RESULTS AND LIMITATIONS A total of 2203 patients (stages IIA, n=1060; IIB, n=869; and IIC, n=274) met the inclusion criteria. Overall, 83% of patients underwent primary chemotherapy, while 17% underwent primary RPLND. Stratified by stage, use of primary chemotherapy was 78%, 88%, and 86% for stages IIA, IIB, and IIC, respectively. Overall, 24% of patients underwent PC-RPLND. Factors independently associated with a lower likelihood of undergoing primary RPLND were a more recent diagnosis and a higher clinical nodal stage. Conversely, patients treated at high-volume facilities were more likely to receive primary RPLND. Factors associated with a higher likelihood of undergoing PC-RPLND included a higher clinical nodal stage, treatment at a high-volume center, and a greater distance of patient travel. Associations based on serum tumor markers could not be assessed. CONCLUSIONS For clinical stage II NSGCT, nationwide utilization of primary chemotherapy is increasing compared with RPLND and is the preferred therapy for more advanced nodal disease. Primary RPLND may be underutilized in stage IIA disease. Utilization of PC-RPLND is driven by nodal stage as well as accessibility of a high-volume center. PATIENT SUMMARY The use of primary retroperitoneal lymph node dissection (RPLND) in early nodal disease is declining, while upfront chemotherapy is increasingly utilized. Primary RPLND may identify patients who are actually pN0 and would not benefit from systemic chemotherapy. Primary RPLND and postchemotherapy RPLND are performed more frequently at centers of excellence.
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Affiliation(s)
- Rashed Ghandour
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Caleb Ashbrook
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yuval Freifeld
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jose M El-Asmar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Scott Eggener
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Solomon Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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14
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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.
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15
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Dieckmann KP, Richter-Simonsen H, Kulejewski M, Ikogho R, Zecha H, Anheuser P, Pichlmeier U, Isbarn H. Testicular Germ-Cell Tumours: A Descriptive Analysis of Clinical Characteristics at First Presentation. Urol Int 2018; 100:409-419. [PMID: 29649815 DOI: 10.1159/000488284] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/08/2018] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Clinical characteristics of testicular germ cell tumours (GCTs) apparently change over time, and some vary geographically. The aim of this study is to document the clinical profile of contemporary GCT patients. PATIENTS AND METHODS Four hundred twenty-two Caucasian GCT-patients treated in one German centre during 2000-2017, were analysed in terms of patient-age, laterality, histology, tumour-size, clinical stages (CS), pathological (pT)-stages and serum biomarker expression. The results were analysed descriptively and compared with the literature. RESULTS Median age was 36 years and 60.2% had seminoma. Βeta-human chorionic gonadotropin was expressed in 37.9% and alpha Fetoprotein in 25.6%. CS1 presenting stage was 66.6% of all GCT patients, 79.1% in seminoma, and 47.6% in nonseminoma. Tumour size was significantly associated with pT-stages and CS. Patients >50 years had significantly more seminoma (77.6%) than younger ones (57.9%). Comparison with literature data revealed a shifting towards higher age, lower CS, higher proportion of seminoma and striking differences of characteristics among geographic regions. CONCLUSIONS A typical contemporary clinical profile of testicular GCTs is presented in this study. Median age, relative incidence of seminoma and proportion of CS1 appear to be increasing over time. Striking differences among ethnic groups regarding the characteristics of GCT require further investigation.
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Affiliation(s)
- Klaus-Peter Dieckmann
- Albertinen Krankenhaus Hamburg, Klinik für Urologie, Hamburg, Germany.,Asklepios Klinik Altona, Hodentumorzentrum Hamburg, Hamburg, Germany
| | | | | | - Raphael Ikogho
- Albertinen Krankenhaus Hamburg, Klinik für Urologie, Hamburg, Germany
| | - Henrik Zecha
- Albertinen Krankenhaus Hamburg, Klinik für Urologie, Hamburg, Germany
| | - Petra Anheuser
- Albertinen Krankenhaus Hamburg, Klinik für Urologie, Hamburg, Germany
| | - Uwe Pichlmeier
- Universitätsklinikum Hamburg Eppendorf, Zentrum für Experimentelle Medizin, Institut für Medizinische Biometrie und, Hamburg, Germany
| | - Hendrik Isbarn
- Universitätsklinikum Hamburg Eppendorf, Martini-Klinik, Hamburg, Germany
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