Commentary on to “Clinicopathologic predictors of outcomes in children with stage I testicular germ cell tumors: A pooled post hoc analysis of trials from the Children's Oncology Group”

Abstract

I commend the authors for studying clinical stage I testis germ cell tumor (TGCT) to identify predictors for relapse during surveillance and I appreciate the challenges that come with analyzing clinical management of a relatively rare disease [ [1] Singla N. Wong J. Singla S. Krailo M. Huang L. Shaikh F. et al. Clinicopathologic predictors of outcomes in children with Stage I testicular germ cell tumors: a pooled post hoc analysis of trials from the Children's Oncology Group. J Pediatr Urol. 2022; (In press https:://doi.org/10.1016/j.jpurol.2022.04.022) Google Scholar ]. Nonetheless, potential biases should be considered when interpreting the results. The authors analyzed multiple data points (age and pT stage at diagnosis, tumor markers and pathology specimen characteristics) to determine which, if any, affect risk of relapse, development of secondary malignant neoplasm or death during surveillance. Surveillance protocols were not the same for all patients, which the authors acknowledged is a potential selection bias. Of the data points analyzed, only age and AFP level were available for all 106 patients. Tumor pT stage was unknown in 27 percent, beta-HCG unknown in 46 percent and histology unknown in 25 percent of the study population. The authors explained the incidences of unknown, stating that in order to maintain statistical integrity they reported “unknown” unless the full complement of pathologic variables was available. But missing data for a large proportion of a study population could bias results, regardless of the reason for the data missing. Response to commentary re: Clinicopathologic predictors of outcomes in children with stage I testicular germ cell tumors: A pooled post hoc analysis of trials from the Children's oncology groupJournal of Pediatric UrologyPreviewPediatric and adolescent patients with testicular germ cell tumors (TGCT) are a particularly challenging population to study given the relatively uncommon incidence of TGCT in children. Unlike in adults, there are no reliable prognostic features to individualize risk of relapse among children with low-stage TGCT. Given this pressing clinical need, herein we leveraged data from three prospective cooperative trials to identify clinicopathologic features predictive for relapse in children with stage I TGCT. Full-Text PDF