Seminoma Clinical Stage 1 - Patterns of Care in Germany

Dieckmann, Klaus‐Peter; Dralle-Filiz, Inken; Heinzelbecker, Julia; Matthies, Cord; Bedke, Jens; Ellinger, Jörg; Sommer, Jörg; Haben, Björn; Souchon, Rainer; Anheuser, Petra; Pichlmeier, Uwe

doi:10.1159/000443214

Cited by 19 publications

(18 citation statements)

References 40 publications

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“…We additionally used reimbursement data, which provides us with a clear and understandable basis for our cost calculations. When compared to other recent studies on treatment patterns for CS I TC patients, our study reports similar epidemiological data with surveillance being on the rise [24, 25]. There are several limitations to our work.…”

Section: Discussionsupporting

confidence: 63%

Economy of Standards: European Association of Urology Guideline Changes Influence Treatment Costs in Stage I Testicular Cancer Patients

John¹,

Baumgart

Worst

et al. 2018

Urol Int

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Objective: The study aimed to calculate direct medical costs (DMC) during the first year of diagnosis and to evaluate the impact of guideline changes on treatment costs in clinical stage (CS) I testicular germ cell tumor (TGCT) patients in a German healthcare system. Materials and Methods: Healthcare expenditures as DMC during the first year of diagnosis for 307 TGCT patients in CS I treated at our institution from 1987 to 2013 were calculated from the statutory health insurance perspective using patient level data. Three periods were defined referring to the first European Association of Urology (EAU) guideline in 2001 as well as to subsequent major guideline changes in 2005 and 2010. Data source for cost calculations were the German Diagnosis Related Groups system for inpatient stays (version 2014) and the German system for reimbursement of outpatient care (EBM – Einheitlicher Bewertungsmaßstab, edition 2014). Results: During our 25 years of study period, mean DMC in the first year after diagnosis for the entire cohort of TGCT patients in CS I almost halved from EUR 13.000 to EUR 6.900 (p < 0.001). From 1987 to 2001, DMC for CS I seminomatous germ cell tumor (SGCT) patients were EUR 13.790 ± 4.700. From 2002 to 2010, mean costs were EUR 10.900 ± 5.990, and from 2011 to 2013, mean costs were EUR 5.190 ± 3.700. For CS I non-seminomatous germ cell tumor (NSGCT) patients, from 1987 to 2001, mean DMC were EUR 11.650 ± 5.690. From 2002 to 2010, mean costs were EUR 11.230 ± 5.990, and from 2011 to 2013, mean costs were EUR 11.170 ± 7.390. Follow-up examinations became less frequent over time, which caused a significant cost reduction for NSGCT (p = 0.042) while costs remained stable for SGCT. When adding costs of relapse treatment, active surveillance (AS) was the most cost-effective adjuvant treatment option in CS I NSGCT whereas one course carboplatin or AS caused similar expenditures in SGCT patients. Conclusion: The introduction of the EAU guidelines in 2001 caused a decrease in DMC in CS I seminoma patients. This cost reduction mainly took place due to the declining importance of radiation therapy. No substantial changes were seen in patients with CS I NSGCT. Costs for follow-up care also diminished, but to a lesser degree. Even when considering expenditures for relapse treatment, AS remained cost-effective in CS I TCGT patients. Our data show that evidence-based medicine in TGCT can reduce DMC in the first year after diagnosis.

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Section: Discussionsupporting

confidence: 63%

Economy of Standards: European Association of Urology Guideline Changes Influence Treatment Costs in Stage I Testicular Cancer Patients

John¹,

Baumgart

Worst

et al. 2018

Urol Int

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“…This finding is clearly conflicting with the current understanding of germ cell cancer biology since all of the recent guidelines consider an AFP elevation to be equivalent with the diagnosis of non-seminomatous GCT [15,20,21] . The present report indicates that there is a small proportion of patients with pure seminoma who may indeed have non-pathologic AFP elevations.…”

Section: Discussionmentioning

confidence: 80%

Pure Testicular Seminoma with Non-Pathologic Elevation of Alpha Fetoprotein: A Case Series

Dieckmann¹,

Anheuser²,

Simonsen³

et al. 2017

Urol Int

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Background: Pure testicular seminoma does not express alpha fetoprotein (AFP). However, seminoma patients with mildly elevated serum AFP levels are increasingly reported. As this finding may prompt unwarranted treatment measures, we reviewed our experience with AFP levels in seminoma. Patients and Methods: We retrospectively registered AFP levels in 254 consecutive seminoma patients, and in 196 male controls with non-malignant diseases. In those with elevated AFP levels, we re-examined the orchiectomy specimens histologically. We reviewed the clinical course and looked for hepatic disorders. Results: Elevated AFP levels were found in 5 patients (1.97%, 95% CI 0.19-3.68) and in 4 controls (2.04%, 95% CI 0.06-4.02). The elevations were modest and kept elevated throughout the clinical course. No hepatic disorders were recorded. Histologically, pure seminoma was confirmed. Conclusion: Unspecific AFP elevations occur in about 2% of seminoma patients. Care-givers should be aware of this particular subgroup of seminoma patients to avoid unwarranted treatment burden.

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“…Disease-specific survival reached 100% with BEP administered at relapse (7). In later years, evidence showing that single-dose carboplatin provided similar oncological outcomes with fewer side effects led to RT losing favor as a first-line treatment (8).…”

Section: Discussionmentioning

confidence: 99%

A Rare Tumor: Small Cell Prostate Carcinoma Case Report

Aydın¹,

Bolat²,

Taşlı³

et al. 2018

uob

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IntroductionTesticular cancer accounts for 1-1.5% of all cancers in men and 5% of male urological malignancies. It is usually seen between the ages of 15 and 35. In the USA, it is the most common malignancy among men aged 20-40 years and the second most common malignancy after leukemia among adolescents aged 15-19 years. The prevalence of bilateral germ cell tumor (GCT) is 2.5%, with 0.6% of these being synchronous tumors and 1.9% being metachronous contralateral tumors (1).The vast majority (90-95%) of testicular tumors are GCTs. The most common histological type of GCT is seminoma (55%), which peaks between the ages of 30-40 years. Non-seminomas account for 40% and peak between the ages of 20-30 years (2). Stage 1 seminomas comprise the majority (80-85%) of GCTs diagnosed in daily practice (3,4). The 10-year overall Objective: Treatment modalities applied after orchiectomy in early-stage germ cell tumors (GCTs) include significant changes in each new study. In this study we reevaluated the treatment approaches used in our hospital between 2010-2014 according to current guidelines. Materials and Methods: We retrospectively evaluated the oncologic treatments and follow-up data of 32 patients who underwent radical orchiectomy between January 2010 and December 2014 due to testicular tumor and were diagnosed with early stage GCT in the Urology Clinic of Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital of University of Health Sciences. Results: Of 19 patients diagnosed with stage 1 seminomas, 3 patients in the low risk group were followed. Of 4 patients who received single-dose carboplatin therapy, 2 were at low risk and 2 were at high risk. Therefore, 2 patients at low-risk had overtreatment. Twelve patients were treated with radiotherapy (RT) that was no longer recommended in guidelines after 2014. Two patients in the low risk group of stage 1 non-seminoma were followed. One of them had recurrence at 12 months, and received 3 cycles of bleomycin + etoposide + cisplatin (BEP) according to current guidelines. Four patients with stage 1 non-seminoma underwent 2 cycles of BEP because they were considered at high risk. These patients are now recommended to receive 1 cycle BEP according to the current guidelines. While 4 patients with stage 1 mixed GCT were followed because of low risk, one patient was administered 2 cycle of BEP based on the old guidelines, at that time because of high risk. In the seminoma group that was administered RT, acute myeloblastic leukemia and oligospermia toxicity were detected, but these were not observed in the carboplatin group. One of high-risk non-seminoma patients who received 2 doses of BEP developed Myelodysplastic syndrome. Conclusion: Early-stage GCTs have high cancer-specific and overall survival rates with appropriate treatment approaches. Although there are still controversial issues regarding their management, treatment approaches are changing with each study. Therefore, it is crucial to remain informed about current international guidelines and...

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Seminoma Clinical Stage 1 - Patterns of Care in Germany

Cited by 19 publications

References 40 publications

Economy of Standards: European Association of Urology Guideline Changes Influence Treatment Costs in Stage I Testicular Cancer Patients

Economy of Standards: European Association of Urology Guideline Changes Influence Treatment Costs in Stage I Testicular Cancer Patients

Pure Testicular Seminoma with Non-Pathologic Elevation of Alpha Fetoprotein: A Case Series

A Rare Tumor: Small Cell Prostate Carcinoma Case Report

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