MP40-10 TESTICULAR TUMOR SIZE IS ASSOCIATED WITH NONLOCALIZED DISEASE AT DIAGNOSIS

Abstract

You have accessJournal of UrologyPenile & Testicular Cancer I (MP40)1 Sep 2021MP40-10 TESTICULAR TUMOR SIZE IS ASSOCIATED WITH NONLOCALIZED DISEASE AT DIAGNOSIS Vidit Sharma, Patrick M. Lec, Katherine E. Fero, Andrew T Lenis, Joseph D. Shirk, Abhishek Venkataramana, Michael S. Leapman, Karim Chamie, Christopher S. Saigal, and Mark S. Litwin Vidit SharmaVidit Sharma More articles by this author , Patrick M. LecPatrick M. Lec More articles by this author , Katherine E. FeroKatherine E. Fero More articles by this author , Andrew T LenisAndrew T Lenis More articles by this author , Joseph D. ShirkJoseph D. Shirk More articles by this author , Abhishek VenkataramanaAbhishek Venkataramana More articles by this author , Michael S. LeapmanMichael S. Leapman More articles by this author , Karim ChamieKarim Chamie More articles by this author , Christopher S. SaigalChristopher S. Saigal More articles by this author , and Mark S. LitwinMark S. Litwin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002055.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Primary testicular tumor size >3 cm was recently added to the American Joint Commission on Cancer’s (AJCC) 8th edition as a criterion for tumor stage 1b in seminomas but not non-seminomatous germ cell tumors (NSGCTs). We analyzed the association of testicular tumor size with nonlocalized disease at diagnosis to determine if incorporating tumor size into staging improves discernment of metastatic propensity. METHODS: We queried the National Cancer Database (NCDB) for patients with testicular seminomas and NSGCTs in 2004–2016. We used fixed-effects multivariable logistic regressions to associate testicular tumor size and nonlocalized disease at diagnosis, defined as any cN+/M+/S+. Regressions adjusted for sociodemographic variables and AJCC 7th edition primary tumor stage that accounted for lymphovascular invasion (pT2) and involvement of the tunica vaginalis (pT2), spermatic cord (pT3), and scrotum (pT4). Significant associations of tumor size with nonlocalized disease were further characterized using non-linear restricted cubic splines to inform tumor size thresholds. RESULTS: Among 16,181 seminomas and 13,804 NSGCTs, 25.1% and 52.2% were nonlocalized at diagnosis, respectively (p<0.01 for difference). Figure 1A demonstrates that patients in higher tumor size deciles had a higher risk of nonlocalized disease at diagnosis for both seminomas and NSGCTs. On multivariable regression, 5 cm increases in tumor size were associated with nonlocalized disease in both seminoma (OR 2.29, 95% CI 2.13-2.47, p<0.001) and NSGCT (OR 1.75, 95% CI 1.62-1.89, p<0.001) with modest increases in area under the curve: 0.615 to 0.664 for seminoma and 0.638 to 0.662 for NSGCT. Restricted cubic splines demonstrated inflection points at about 3 cm and 4 cm for seminoma and NSGCT, respectively (Figure 1B). CONCLUSIONS: The addition of testicular tumor size to primary tumor staging modestly improves prediction of nonlocalized disease in both seminoma and NSGCTs. Our results support the inclusion of a 3 cm tumor size threshold into the primary tumor staging of seminomas and support investigations regarding the addition of a 4 cm tumor size threshold for NSGCTs. Further study is warranted using more granular datasets to verify these findings. Source of Funding: Vidit Sharma is supported by the VA HSRD fellowship © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e718-e718 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vidit Sharma More articles by this author Patrick M. Lec More articles by this author Katherine E. Fero More articles by this author Andrew T Lenis More articles by this author Joseph D. Shirk More articles by this author Abhishek Venkataramana More articles by this author Michael S. Leapman More articles by this author Karim Chamie More articles by this author Christopher S. Saigal More articles by this author Mark S. Litwin More articles by this author Expand All Advertisement Loading ...