MP40-13 WHEN IS A SEMINOMA NOT A SEMINOMA? THE INCIDENCE, RISK FACTORS AND MANAGEMENT OF PATIENTS WITH TESTICULAR SEMINOMA WITH DISCORDANT ELEVATED SERUM ALPHA-FETOPROTEIN

Abstract

You have accessJournal of UrologyPenile & Testicular Cancer I (MP40)1 Sep 2021MP40-13 WHEN IS A SEMINOMA NOT A SEMINOMA? THE INCIDENCE, RISK FACTORS AND MANAGEMENT OF PATIENTS WITH TESTICULAR SEMINOMA WITH DISCORDANT ELEVATED SERUM ALPHA-FETOPROTEIN Katherine E. Fero, Patrick Lec, Vidit Sharma, Andrew Lenis, Josiah Low, Mark Litwin, Michael Leapman, and Karim Chamie Katherine E. FeroKatherine E. Fero More articles by this author , Patrick LecPatrick Lec More articles by this author , Vidit SharmaVidit Sharma More articles by this author , Andrew LenisAndrew Lenis More articles by this author , Josiah LowJosiah Low More articles by this author , Mark LitwinMark Litwin More articles by this author , Michael LeapmanMichael Leapman More articles by this author , and Karim ChamieKarim Chamie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002055.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The detection of elevated serum alpha-fetoprotein (AFP) in patients with pure seminoma testicular germ cell tumors (GCT) is a discordant finding that implies the presence of occult non-seminomatous GCT (NSGCT) elements. The histologic misclassification of a NSGCT as a pure seminoma has considerable therapeutic implications, as the two vary in the appropriateness of utilization of adjuvant treatments, or active surveillance. The incidence and management patterns of pure seminoma histology with elevated AFP remains understudied; thus, we aimed to described the incidence, clinical and demographic factors, and treatment patterns associated with discordant elevated AFP findings in patients with pure seminomatous histology. METHODS: We queried the National Cancer Database to identify patients with testicular GCT diagnosed between 2011 through 2015. We grouped patients based on histologic diagnosis and pre-operative serum AFP level and defined an outcome variable for type of adjuvant therapy patients received after orchiectomy, if any. RESULTS: Of 18,616 patients diagnosed with testicular GCT, 53% (N=9849) had pure seminomatous histology and 8.3% (N=821) had an elevated serum AFP pre-operatively. Non-white patients with seminoma were more likely to have a pre-op elevation of AFP (OR 1.42; 95% CI: 1.10–1.83); patients treated at higher volume centers were less likely to have a pre-op elevation AFP (0.66, 95% CI: 0.53–0.83). Patients with stage I seminoma with elevated AFP underwent adjuvant radiation more frequently than those with NSGCT (15% vs 0.2%, p<0.01) and less frequently received retroperitoneal lymph node dissection (RPLND) (1.9% vs 11.1% p<0.01). More patients with stage II seminoma with elevated AFP underwent adjuvant radiation than those with NSGCT (21.9% vs 0.1%, p<0.01) and fewer underwent adjuvant chemotherapy (54.4 vs 75%, p<0.01) or RPLND (8.8% vs 17.4%, p<0.01) (Figure 1). CONCLUSIONS: In this national study, approximately 8% of patients with pure seminomatous GCTs had diagnostically discordant elevated pre-operative AFP levels. Despite recommendations to manage these patients as NSGCT, patients with seminoma and elevated AFP were managed in a fashion comparable to those with seminoma and normal AFP levels. Source of Funding: KEF is supported by H&H Lee UCLA Surgical Scholars Program and Urology Care Foundation resident research award.Veterans Affairs Health Services Research program supports author V. Sharma © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e719-e719 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Katherine E. Fero More articles by this author Patrick Lec More articles by this author Vidit Sharma More articles by this author Andrew Lenis More articles by this author Josiah Low More articles by this author Mark Litwin More articles by this author Michael Leapman More articles by this author Karim Chamie More articles by this author Expand All Advertisement Loading ...