Testicular Tumour Size and Rete Testis Invasion as Prognostic Factors for the Risk of Relapse of Clinical Stage I Seminoma Testis Patients Under Surveillance: a Systematic Review by the Testicular Cancer Guidelines Panel

Boormans, Joost L.; Castro, J. Mayor de; Marconi, Lorenzo; Yuan, Yuhong; Pes, M. Pilar Laguna; Bokemeyer, Carsten; Nicolai, Nicola; Algaba, Ferrán; Oldenburg, Jan; Albers, Peter

doi:10.1016/j.eururo.2017.09.025

Cited by 99 publications

(73 citation statements)

References 34 publications

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“…This finding corresponds to the experience made in seminoma, where increasing tumour size is significantly associated with the risk of progression [52]. Bhardwa et al [53] noted larger tumour sizes in metastasized patients, but that association was not significant.…”

Section: Discussionsupporting

confidence: 86%

Testicular Germ-Cell Tumours: A Descriptive Analysis of Clinical Characteristics at First Presentation

et al. 2018

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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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Section: Discussionsupporting

confidence: 86%

Testicular Germ-Cell Tumours: A Descriptive Analysis of Clinical Characteristics at First Presentation

et al. 2018

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“…Though the incidence rate increases over time, the mortality rate declines due to improved multimodal treatment options within the last few decades [2]. In terms of treatment and prognosis, TGCTs are subdivided into two major groups: Seminoma and non-seminomatous germ cell tumors [3]. In metastatic TGCT, prognosis and therapy depend on the location of metastases and tumor marker levels [4].…”

Section: Introductionmentioning

confidence: 99%

“…However, these tumor markers are increased in only about 60% of TGCT patients. Moreover, in pure seminoma patients, only β-HCG is increased in about 20% of patients [3,4]. Besides a lack of sensitivity, false positive ("non-specific") elevations of AFP in patients with non-seminomatous germ cell cancer is possible and can be caused by infectious liver disease, liver cirrhosis, or hepatocellular carcinoma [5,6].…”

Section: Introductionmentioning

confidence: 99%

MicroRNAs as Appropriate Discriminators in Non-Specific Alpha-Fetoprotein (AFP) Elevation in Testicular Germ Cell Tumor Patients

Lembeck

Puchas

Hutterer

et al. 2020

ncRNA

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Testicular germ cell tumors (TGCTs) are the most commonly diagnosed malignancies in younger men. The monitoring of disease course and recurrence is supported by traditional tumor markers, including α-fetoprotein (AFP). AFP is physiologically synthesized in the liver and can be detected at increased levels in testicular cancer patients as well as under other benign liver diseases, which have been reported as a misleading cause of interpretation of TGCTs clinical course. A cluster of stem cell-associated microRNAs has been reported to outperform traditional tumor markers in newly diagnosed TGCTs, but the value of these microRNAs to differentiate between specific and unspecific AFP elevations, has never been reported. We report here a patient with chronic hepatitis B and normal liver related blood values presenting with a surgically removed primary TGCT and elevated AFP levels. Clinical staging revealed a suspect retroperitoneal metastatic lymph node together with other risk factors and first line treatment with PEB chemotherapy was administered. During curative treatment significantly rising AFP levels led to the assumption of chemo-resistant disease, mandating the initiation of salvage chemotherapy and surgical removal of the putative lymph node metastases. The AFP levels continuously decreased with the interruption of chemotherapeutic agents, indicating a chemotherapy-induced liver toxicity on the basis of pre-existing liver disease. MiR-371a-3p serum levels were not detectable in serum samples with elevated AFP levels. In conclusion, miR-371a-3p may be a reliable biomarker to differentiate between non-specific AFP elevations in TGCTs patients.

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“…RTI is explicitly considered by AJCC as a pathological feature that does not change staging (based on large contemporary cohorts data) [2]. Thus, the clinical signi cance of RTI remains controversial [7]. Combining our experience, in particular and as mentioned before, the observed signi cant association between RTI and increased tumor size (P<0.0001, Table 1), with large retrospective data whose importance is recognized in international guidelines [4,13], RTI may still have a role in clinical practice.…”

Section: Impact For Prognosis and Clinical Decisionmentioning

confidence: 99%

“…These factors, albeit retrospectively identi ed, have been considered recurrence predictors [5]. So far, they have not been validated prospectively, except that in the absence of both of them, it constituted an indication of low recurrence rate (6%) [6] and therefore the evidence for its routine use in clinical practice is limited (in patients undergoing surveillance) [7]. Additionally, other factors should be considered for treatment decision, such as, patient preference or compliance with recommended follow-up protocols.…”

Section: Introductionmentioning

confidence: 99%

Clinical implications of the American Joint Committee on Cancer (AJCC) 8th edition update in seminoma pT1 subclassification

Fontes‐Sousa

Lobo

Magalhães

et al. 2020

Preprint

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Abstract Background Seminoma accounts for 30-50% of Testicular Germ-Cell Tumors (TGCT) - the most common solid malignancy in men aged 15-35 years. The American Joint Committee on Cancer (AJCC) 8th edition (2018) created the subclassifications pT1a (tumor size < 3 cm) and pT1b (≥ 3 cm), despite not universally recognized. The authors propose to further understand its potential impact in clinical practice, by reviewing current evidence and reviewing clinical cases at their institutions.Methods: All consecutive cases of seminoma stage I pT1 treated at two institutions between January 2005 and December 2016 were included. Clinical data were retrieved, and variables were analyzed using SPSS. Review of relevant literature on the topic.Results: Seminoma pT1 was identified in 58 patients. By using newly AJCC criteria, 29 (50.0%) would have been staged as pT1a and 29 (50.0%) pT1b. Median follow- up time 5.8 years. Three recurrences were recorded (2 in pT1a and 1 in pT1b, all under surveillance protocol); no deaths occurred. Rete testis invasion (RTI) and extensive necrosis (EN) were associated with pT1b (P<0.0001 and P=0.023, respectively), therefore pT1b was associated with RTI and EN, known adverse biological features, but the clinical impact could not to be assessed with the present methodology. Discussion: In our population, the retrospective analysis of the newly created AJCC criteria showed no significant difference in recurrence or death, although pT1b was associated to adverse biological markers. Our results also confirm an excellent prognosis, regardless of subcategorization, thus a larger population and a longer follow-up time are needed to understand the impact of the recently updated criteria. We would recommend using the latest AJCC staging system, although the individual risk of relapse, long-term toxicities and patient preferences should be taken into account when considering surveillance or active treatment options.

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Testicular Tumour Size and Rete Testis Invasion as Prognostic Factors for the Risk of Relapse of Clinical Stage I Seminoma Testis Patients Under Surveillance: a Systematic Review by the Testicular Cancer Guidelines Panel

Cited by 99 publications

References 34 publications

Testicular Germ-Cell Tumours: A Descriptive Analysis of Clinical Characteristics at First Presentation

Testicular Germ-Cell Tumours: A Descriptive Analysis of Clinical Characteristics at First Presentation

MicroRNAs as Appropriate Discriminators in Non-Specific Alpha-Fetoprotein (AFP) Elevation in Testicular Germ Cell Tumor Patients

Clinical implications of the American Joint Committee on Cancer (AJCC) 8th edition update in seminoma pT1 subclassification

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