Seminomatous Germ Cell Tumors Research Articles

MP4-01 DEVELOPMENT OF INTERMEDIATE AND HIGH-RISK PROSTATE CANCER AFTER TESTICULAR CANCER

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History I1 Apr 2015MP4-01 DEVELOPMENT OF INTERMEDIATE AND HIGH-RISK PROSTATE CANCER AFTER TESTICULAR CANCER Andrew Riggin and M. Minhaj Siddiqui Andrew RigginAndrew Riggin More articles by this author and M. Minhaj SiddiquiM. Minhaj Siddiqui More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.144AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A history of testicular cancer has been suggested to have an association with an increased risk of developing prostate cancer (PCa) in epidemiology studies. We hypothesized that there may be an increased risk of developing intermediate to high-risk PCa as well. METHODS This is a retrospective case-control study. The Surveillance, Epidemiology and End Results (SEER) registry was queried to identify men with a history of testicular cancer (case group) and men with a history of melanoma (controls). Melanoma was used as a control group because, to our knowledge, there is no association of melanoma and PCa. Men were excluded if they were not 40 years of age or older to allow for sufficient age for PCa diagnosis. PCa incidence was only counted if it occurred at least 5 years after the diagnosis of their primary cancer to allow for possible temporal effect of the primary malignancy. Incidence of total and intermediate to high-risk PCa(Gleason score ≥ 7) was compared using Kaplan-Meier (KM) curves. Cox proportional hazards models were utilized to assess for associations of PCa (JMP 10, SAS Inc). RESULTS 147,044 men with melanoma and 32,435 men with testicular cancer were identified. PCa was diagnosed in 3,205 men. The cumulative incidence of all PCa by age 80 was 2.8% in the control melanoma cohort and 12.6% in the case cohort of men with history of testicular cancer (p<0.0001 for KM survival curves, Figure 1). For intermediate/high-risk disease, the incidence was 1.1% versus 5.8% for each cohort respectively (p<0.0001 for KM survival curves, Figure 2). No association with PCa was seen with non-seminomatous versus seminomatous germ cell tumors. Upon multivariate analysis, testis cancer was associated with an increased risk of all PCa (HR 4.7, p<0.0001) and intermediate/high-risk PCa (HR 5.2, p<0.0001) when controlling for race and radiation history. CONCLUSIONS A history of testicular cancer is associated with an increased risk of intermediate/high risk PCa. Future studies may be warranted to determine if men with a history of testicular cancer should have closer screening for PCa. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e26-e27 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Riggin More articles by this author M. Minhaj Siddiqui More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A novel rapid access testicular cancer clinic: prospective evaluation after one year.

Our institution has recently developed a rapid access outpatient clinic to investigate men with testicular lumps and/or pain suspicious for testicular cancer (TCa). To present our experience after 12 months. All referrals to the rapid access testicular clinic (RATC) clinic were prospectively analysed from 01/01/2013 to 01/01/2014. The primary outcome variable was incidence of TCa in the referred patient cohort. Secondary outcome variables were waiting times prior to clinical review and waiting times prior to radical orchidectomy in patients diagnosed with TCa. Seventy-four new patients were referred to the RATC during the 1-year period and the mean age was 34 (range 15-81 years). TCa was the most common diagnosis and was found in 18 (25 %) patients. Patients diagnosed with TCa underwent radical orchidectomy, a median of 3 (range 1-5) days after their initial GP referral. Patients requiring surgical intervention for benign scrotal pathology underwent their procedure a median of 32 (range 3-61) days after their initial referral. Of the 18 patients diagnosed with TCa, 9 (50 %) were diagnosed with a seminomatous germ cell tumour on histopathology. The RATC is a new initiative in Ireland that provides expedient and definitive treatment of patients with newly diagnosed TCa. Early treatment will ultimately improve long-term prognosis in this patient cohort.

Bilateral testicular germ cell tumors.

392 Background: Germ cell tumors (GCTs), both seminomatous and non-seminomatous, account for greater than 90% of testicular cancers. While bilateral testicular GCTs are rare, the incidence of bilateral tumors has increased over time. Methods: 668 cases of bilateral and 38,593 cases of unilateral testicular GCTs were reported between 1973 and 2011 by the SEER database. Patient characteristics and tumor features were analyzed. Results: The incidence of bilateral GCTs among men with testicular GCTs was 1.7% (668 of 39,261 total cases). Among the 668 men with bilateral GCTs, 53% (n=353) of second GCTs occurred within three years after the first cancer. 29% (n=196) of bilateral tumors occurred synchronously. Among patients with bilateral GCTs, 378 first GCTs and 466 second GCTs were seminomatous. 43% of bilateral cases were concordant seminomatous GCTs, 16% were concordant non-seminomas, and 41% were discordant histologies. 68% of unilateral GCTs, 70% of first GCTs, and 82% of second GCTs were staged as Localized disease. Testicular cancer was the cause of death for 4% (n=1,630) of men with a unilateral GCT and 1% (n=8) of men with bilateral GCTs. A second malignant neoplasm (SMN) was the cause of death for 2% (n=736) of men with a unilateral GCT and 2% (n=16) of men with bilateral GCTs. Conclusions: Among men with bilateral testicular GCTs, 59% had concordant histological diagnoses between their first and second tumor. Most (53%) second cancers among men with bilateral tumors occurred within three years after diagnosis of first cancers. Men who experience bilateral testicular GCTs do not appear to have an increased risk of death due to testicular cancer or a subsequent non-germ cell malignant neoplasm compared to men with a unilateral testicular GCT. [Table: see text]

Craniocaudal Retroperitoneal Node Length as a Risk Factor for Relapse From Clinical Stage I Testicular Germ Cell Tumor

The purpose of this study was to investigate whether retroperitoneal craniocaudal nodal length or nodal volume predicts relapse risk in stage I testicular cancer. We retrospectively reviewed 826 testicular cancer patients. Of these 826 patients, 118 had stage I disease and either less than 2 years of surveillance or retroperitoneal lymph node dissection with no adjuvant chemotherapy. These patients formed our analytic cohort, and 3D nodal volumes and craniocaudal nodal length were measured. Association between relapse risk and craniocaudal nodal length and nodal volume was evaluated using univariable or multivariable logistic regression models adjusted for known prognostic factors. Sixty-six (56%) of 118 patients had nonseminomatous germ cell tumor and 52 (44%) had seminomatous germ cell tumor. Craniocaudal nodal length proved to be an independent risk factor in nonseminomatous germ cell tumors using a multivariable logistic regression model adjusting for other potential known risk factors of embryonal predominance and lymphovascular invasion. For every 3-mm increase in craniocaudal nodal length, the risk of relapse increased by 52% (odds ratio [OR], 1.52; 95% CI, 1.03-2.25). For patients with seminomas, only primary tumor size was an independent risk factor for relapse (1.34, 1.02-1.75). In nonseminomatous germ cell tumors, craniocaudal nodal length was shown to be associated with increased risk of relapse independently of other known risk factors. If validated in an independent cohort, craniocaudal nodal length could provide important additional information to inform management decisions in these patients.

Abstract 3394: In-depth gene expression profiling of seminomatous testicular germ cell tumors

Abstract In depth Whole Transcriptome Analysis by RNA-Seq was used to compare the expression profile of testicular germ cell tumors with the histology of seminoma and normal testis. From this analysis we identified a large number of genes that showed differential expression with statistically high significance, (p&amp;lt;0.01, &amp;gt;2X FC). The list included genes related to stem cell pleuripotency (NANOG, POU5F1), proliferation (KRAS, CCND2), a number of non-coding RNAs (snoRNAs, miRNA precursors, XIST), and testicular cancer related genes (LDHB, AKAP4). From this list we identified a subset of genes for validation and further screening. We used the OpenArray® RT-qPCR platform to quantitatively screen up to 224 coding and non-coding genes using samples from different testicular germ cell tumors (seminoma and non-seminoma) and normal tissue. Results from these screening experiments will be presented. For research use only. Not for diagnostic procedures. Citation Format: Sunali Patel, Shirley Chu, Lovorka Degoricija, Kathy Y. Lee, Ad J.M Gillis, Martin Rijlaarsdam, Lambert C.J Dorssers, Leendert H.J Looijenga. In-depth gene expression profiling of seminomatous testicular germ cell tumors. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3394. doi:10.1158/1538-7445.AM2014-3394

Mixed Seminomatous Germ Cell Tumor of the Lung in a 58-year-old man

Mixed Seminomatous Germ Cell Tumor of the Lung in a 58-year-old man

Endogenous biotin expression in renal and testicular tumours and literature review.

The aim of this study was to examine endogenous biotin levels in tumour specimens collected from patients with renal and testicular tumours and compare them to the surrounding non-neoplastic surgical margin. Frozen samples were obtained from the Ontario Tumour Bank. Renal and testicular tumour tissue were included in this study. Normal tissue from the negative surgical margins of each tumour served as a control. Biotin detection in tissue specimens was determined using immunohistochemistry (IHC). Specimens collected from 56 patients (36 men and 20 women) were included in this study. Histopathology of the 52 renal tumours included 31 (60%) conventional type RCC, 5 (10%) chromophobe RCC, 5 (10%) papillary RCC, 1 (2%) oncocytoma and 10 (19%) upper tract urothelial carcinoma (UC). The 4 testicular tumours included 1 seminomatous (25%) germ cell tumour and 3 (75%) non seminomatous germ cell tumours. No biotin signal was perceived in all tested tumour samples. Endogenous biotin expression was detected in the matching non-neoplastic surgical margin of tested renal tissues. This lack of staining may prove to be a valuable tool in future studies.

Diagnostic accuracy of integrated (18)F-FDG PET/CT for restaging patients with malignant germ cell tumours.

Evaluation of utility of fluorine-18 fludeoxyglucose ((18)F-FDG) positron emission tomography/CT (PET/CT) for restaging patients with primary malignant germ cell tumours (GCTs). Data of 92 patients (age, 31.94 ± 10.1 years; male/female, 86/6) with histopathologically confirmed malignant GCTs (gonadal, 88; mediastinal, 4; seminomatous, 47 and non-seminomatous, 45) who underwent (18)F-FDG PET/CT for restaging (suspected recurrence/post-therapy evaluation) were retrospectively analysed. Two experienced nuclear medicine physicians reviewed the PET/CT images in consensus, qualitatively and semi-quantitatively [maximum standardized uptake value (SUVmax)]. Histopathology (if available) and clinical/imaging/biochemical follow-up (minimum of 6 months) were employed as the reference standard. (18)F-FDG PET/CT was interpreted as positive in 59 and negative in 33 patients. Local disease was seen in 5, nodal disease in 50 and distant metastasis in 22 patients. PET/CT was true positive in 49, false positive in 10, true negative in 30 and false negative in 3 patients. (18)F-FDG PET/CT showed sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 94.2%, 75.0%, 83.0%, 90.9% and 85.8% overall; 90.0%, 74.0%, 72.0%, 90.9% and 80.8% in seminomatous GCT; and 96.8%, 76.9%, 91.1%, 90.9% and 91.1% in non-seminomatous GCT, respectively. Difference in PET/CT accuracy for seminomatous and non-seminomatous GCTs was not significant (p = 0.263). PET/CT demonstrated disease in 13 patients with negative/equivocal conventional imaging findings and in 9 patients with normal tumour markers. No site- or histology-based difference was seen in SUVmax. (18)F-FDG PET/CT demonstrates high diagnostic accuracy for restaging patients with malignant GCTs. It has comparable diagnostic performance in both seminomatous and non-seminomatous malignant GCTs. The present article demonstrates high diagnostic accuracy of (18)F-FDG PET/CT for restaging both seminomatous and non-seminomatous malignant GCTs in a large patient population.

Clinical outcome of patients with metastatic seminomatous germ cell tumor: Results of a single high-volume cancer center in Japan.

e15539 Background: Metastatic seminomatous germ cell tumor (GCT) is a rare clinicopathologic entity. Here, we report the results of a retrospective analysis of patients with metastatic seminomatous...

Gastrointestinal hemorrhage and gynecomastia as first signs of metastatic testicular choriocarcinoma

Testicular choriocarcinoma is an infrequent non seminomatous germ cell tumor, usually presenting histologically as part of a mixed germ cell tumor, and rarely as pure form. It metastasizes early, usually along hematogenous routes, lungs being the most frequent sites of metastasis. Involvement of the gastro-intestinal tract as metastatic site is extremely uncommon and rarely described in the literature. We report the case of a 47 year-old male with gastric and pulmonary metastases from testicular mixed germ cell tumor mainly represented by choriocarcinoma as histological subtype, presenting with melena and gynecomastia as first clinical signs. Morphological and immunohistochemical analyses of biopsies taken from the endoscopically identified gastric hemorrhagic lesion and from lung nodules showed undifferentiated neoplastic epithelial cells in a necrotic and hemorrhagic background. Coexistence of gynecomastia addressed towards an hormonal-dependent tumor and prompted us to apply further morphological and immunohistochemical analyses, revealing the gonadal primary neoplasm, subsequently confirmed at surgery.

MP2-13 INCIDENCE OF THROMBOEMBOLIC EVENTS AFTER MAJOR ONCOLOGIC UROLOGIC SURGERY IS UNDERESTIMATED IN THE PERIOPERATIVE PERIOD: ANALYSIS OF A NATIONAL DATABASE

Thus, the objective of this study was to analyze the socioeconomic demographics of patients with UTM and DTM. METHODS: All 17 registries comprising the Surveillance Epidemiology and End Results (SEER) database were analyzed from 1988 2008. Patients with descended or undescended testis and a diagnosis of nonseminomatous or seminomatous germ cell tumor were identified. Patients classified as testis not otherwise specified were grouped with DTM. Variables of interest included census county data for % foreign born, educational attainment (less than 9th grade vs less than high school), poverty level, median family income, % unemployed, ethnic or racial minority and rural/urban (populations rural 20,000; metropolitan 1,000,000; unknown/missing/Alaska). Multivariate analysis was used to assess the above variables according to their quartile range and risk of UTM. RESULTS: There were 27,831 (98.3%) men with DTM and 496 (1.7%) men with UTM who comprised the study cohort. Compared to patients with DTM, patients with UTM were more commonly from counties with higher % foreign born (19.9% vs. 17.1%, p 1 million people) communities (p1⁄40.02). On multivariate analysis, residing in a county with greater foreign born inhabitants was associated with greater odds of UTM (highest quartile vs. lowest quartile e OR 1.33, 95% CI 1.004 1.759). CONCLUSIONS: Patients with UTM are more commonly from regions with a greater proportion of foreign born and minority inhabitants, poorer and less educated. These results suggest that indicators of lower SES are associated with UTM and outcomes may be linked to access to adequate healthcare.

MP10-03 THE INFLUENCE OF ACCESS TO CARE ON ADHERENCE TO CLINICAL PRACTICE GUIDELINES FOR TESTIS CANCER

You have accessJournal of UrologyPenis/Testis: Benign & Malignant Disease II1 Apr 2014MP10-03 THE INFLUENCE OF ACCESS TO CARE ON ADHERENCE TO CLINICAL PRACTICE GUIDELINES FOR TESTIS CANCER C.J. Stimson, Zachary Reardon, Sanjay Patel, Harras Zaid, Samuel Kaffenberger, Daniel Barocas, Matthew Resnick, and Sam Chang C.J. StimsonC.J. Stimson More articles by this author , Zachary ReardonZachary Reardon More articles by this author , Sanjay PatelSanjay Patel More articles by this author , Harras ZaidHarras Zaid More articles by this author , Samuel KaffenbergerSamuel Kaffenberger More articles by this author , Daniel BarocasDaniel Barocas More articles by this author , Matthew ResnickMatthew Resnick More articles by this author , and Sam ChangSam Chang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.459AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Measurement of pre-orchiectomy serum tumor markers (pSTM) in patients with suspected testis cancer (TC) and use of radiation therapy (RT) for clinical Stage IS (cIS) seminoma are recommended processes of care in the National Comprehensive Cancer Network (NCCN) guidelines. We assessed whether factors that influence patient access to care are associated with adherence to these guidelines. METHODS We analyzed all patients with orchiectomy-proven non-seminomatous (NSGCT) and seminomatous (SGCT) germ cell tumors diagnosed between 2004-2011 from the National Cancer Database registry. Separate logistic regression models were fit to determine whether access-related factors predicted pSTM measurement among all TC patients, and use of RT among patients with cIS SGCT. RESULTS 6462 patients met our inclusion criteria, of which 4851/6462 (75%) had pSTM drawn. The cIS SCGT cohort included 527 patients, of which 270/527 (51.2%) received primary RT. While controlling for other clinical and demographic factors, multivariate analysis showed a statistically significant increase in use of pSTM with younger age, treatment at a comprehensive or academic cancer facility, and lower income, while geographic location in the South or Midwest was negatively associated with use of pSTM (Table 1). With regards to utilization of RT for cIS SGCT, patients diagnosed between 2010 and 2011 were less likely to receive RT than those diagnosed prior to 2006 (p<0.05). CONCLUSIONS Evidence-based clinical guidelines recommend pSTM for patients with suspected TC and treatment with primary RT for cIS SGCT. Adherence to these guidelines is variable and is associated with non-clinical, access-related patient features including hospital type and geographic location. Multivariate Analysis: Predictors of Pre-Orchiectomy Tumor Marker Measurement Covariate Odds Ratio 95% Confidence Interval p-value Age 0.99 0.99-1.00 < 0.01 Race White Referent Black 0.88 0.63-1.21 0.43 Other 1.09 0.77-1.55 0.61 Insurance Status Insured Referent Uninsured 1.10 0.93-1.33 0.26 Income < $30,000 Referent $30,000-$34,999 0.80 0.63-1.02 0.08 $35,000-$45,999 0.74 0.58-0.95 0.02 > $45,999 0.72 0.56-0.94 0.02 % of County Residents without High School Degree < 14% Referent 14-19.9% 0.99 0.79-1.23 0.90 20-28.9% 1.09 0.86-1.37 0.48 > 29% 1.23 0.97-1.60 0.09 Geographic Location Northeast Referent South 0.82 0.69-0.99 0.04 Midwest 0.77 0.65-0.90 < 0.01 West 1.01 0.84-1.23 0.85 Distance from Hospital Same zip code Referent < 60 miles 1.21 0.89-1.65 0.22 60-120 miles 0.87 0.56-1.35 0.54 > 120 miles 0.77 0.49-1.21 0.26 Rurality Metro Referent Urban 1.12 0.93-1.36 0.23 Rural 1.53 0.91-2.70 0.11 Hospital Type Community Referent Comprehensive Community 1.34 1.11-1.62 < 0.01 Academic 2.25 1.83-2.77 < 0.01 Charlson Comorbidity Index 0 Referent 1 1.25 0.96-1.64 0.10 > 1 2.29 0.89-5.94 0.89 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e115 Advertisement Copyright & Permissions© 2014MetricsAuthor Information C.J. Stimson More articles by this author Zachary Reardon More articles by this author Sanjay Patel More articles by this author Harras Zaid More articles by this author Samuel Kaffenberger More articles by this author Daniel Barocas More articles by this author Matthew Resnick More articles by this author Sam Chang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Ochratoxin A is not detectable in renal and testicular tumours

Ochratoxin-A (OTA) is one of the most abundant food-contaminating mycotoxins, known for its nephrotoxicity, neurotoxicity, gonadotoxicity, teratogenicity, immunosuppression and carcinogenesis. OTA has been linked to several genitourinary pathologies, including Balkan nephropathy and genitourinary malignancies. We examine OTA levels in serum samples and tumour specimens collected from patients with renal and testicular tumours. Frozen samples were obtained from the Ontario Tumour Bank. Serum specimens, along with renal and testicular tumour biopsies, were included in this study. Normal tissue from the negative surgical margins of each tumour served as a control. OTA levels in serum was measured using the enzyme-linked immunosorbent assay (ELISA), while OTA detection in tissue specimens was determined using immunohistochemistry (IHC). We included specimens collected from 56 patients (36 men and 20 women). Histopathology of the 52 renal tumours included 31 (60%) conventional type renal cell carcinomas (RCC), 5 (10%) chromophobe RCC, 5 (10%) papillary RCC, 1 (2%) oncocytoma and 10 (19%) upper tract urothelial carcinoma (UC). The 4 testicular tumours included 1 seminomatous (25%) germ cell tumour and 3 (75%) non-seminomatous germ cell tumours. OTA was detected in the serum of renal tumour patients, with a range from 0.004 to 0.25 ng/mL (mean: 0.07 and median 0.06 ng/mL). There was no OTA signal detected by IHC staining in all tested renal and testicular tumours. The OTA levels detected in the serum of patients were highly variable and relatively low. No OTA was detected in the tissue samples.

Craniocaudal retroperitoneal node length as a risk factor for relapse from clinical stage I testicular germ cell tumor.

363 Background: To investigate if retroperitoneal craniocaudal nodal length (CCNL) or nodal volume (NV) predicts relapse risk in clinical stage I testicular cancer. Methods: This institutional review board-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant study retrospectively reviewed 826 patients with testicular cancer. One hundred eighteen out of 826 patients forming the analytic cohort had stage I disease and either more than or equal to 2 years surveillance or retroperitoneal lymph node dissection with no adjuvant chemotherapy. 3D NVs and CCNL were measured by two attending physicians in consensus. Association between relapse risk and CCNL/NV was evaluated using univariable/multivariable logistic regression analysis adjusted for known prognostic factors. Results: Sixty six out of 118 patients (56%) had nonseminomatous germ cell tumor (NSGCT) and 52 (44%) had seminomatous germ cell tumor (SGCT). Twenty one percent (25 out of 118) of patients relapsed: 24% (16 out of 66) for NSGCT and 17% (9 out of 52) for SGCT. Eighty percent of relapses were limited to the retroperitoneum; 90% of these were at the site of the largest lymph node. CCNL proved to be an independent risk factor in NSGCT using a multivariable logistic regression model adjusting for other potential known risk factors of embryonal predominance (EP) and lymphovascular invasion (LVI). For every 3 mm increase in CCNL, the risk of relapse increased by 52% (odds ratio [OR]=1.52; 95% CI=1.03- 2.25). For patients with SGCT, only the primary tumor size was an independent risk factor for relapse (OR=1.34; 95% CI=1.02-1.75). Conclusions: In NSGCT, CCNL was shown to be associated with increased risk of relapse independently of other known risk factors. If validated in a larger cohort, CCNL could provide important additional information used to inform management decisions in these patients.

Clinical Profile, Treatment and Survival Outcome of Testicular Tumors: A Pakistani Perspective

Testicular cancer management is considered a marvel of modern science with excellent treatment results. Pakistan has a distinct ethnic variation and geographic distribution but data regarding clinical presentation of testicular tumors and their management is under reported. The objective of this study was to determine clinical profile, treatment modalities and survival outcome of testicular tumors in the Pakistani population. A retrospective review of patients who received treatment for testicular cancer at Shaukat Khanum Cancer Hospital from January 2009 to December 2012 was performed. Patient demographics, clinical features at presentation and treatment modalities were assessed. For categorical variables chi square test was used. Survival was calculated using Kaplan Meier survival curves and Log rank test was employed to determine significance. The most common tumor was mixed germ cell tumor in 49% patients. For all tumor variants except seminoma, stage III was the most common clinical stage at presentation. Majority of patients with non seminomatous germ cell tumors presented in the15-30 year age group as compared to seminoma which was most prevalent in the 30-40 year age group. Orchiectomy followed by chemotherapy was the most common treatment modality in 80% patients. Expected 5 year survival for seminomas and non- seminomatous germ cell tumors was 96% and 90% respectively which was not significantly different (p=0.2). Despite a distinct clinical profile of testicular tumors in Pakistani population, survival is comparable with published reports.

Bone metastases in germ cell tumours: lessons learnt from a large retrospective study

Objective To determine the characteristics of patients with germ cell cancer and bone metastases. Patients and Methods The case records of patients with known germ cell tumours (GCTs) within the Anglian Germ Cell Cancer Group database between January 2005 and March 2011 were reviewed retrospectively. Data were collected for histopathology, presence of bone metastases at diagnosis or relapse, site of bone metastases and imaging method used to confirm bone metastases, treatment received, response to treatment and overall survival. We present here the largest unselected cohort of bone metastases in patients with GCTs. Results In all, 2550 cases of GCTs were reviewed and there was bone involvement in 19 cases. The primary site was either testicular (13/19), mediastinal (1/19) or unknown (5/19). Most cases were non‐seminomatous GCTs (11/19, 58%) and only three cases of seminomatous GCTs (3/19, 16%) with five cases in which diagnosis was based on clinical history and significantly raised GCT markers (5/19, 26%). In all of these five cases β‐human chorionic gonadotrophin was raised and in three α‐fetoprotein was raised, consistent with non‐seminomatous GCT. There were bone metastases at diagnosis (0.51%, 13/2550) or at relapse (0.24%, 6/2550). The sites of bone metastases were the vertebrae (15/19, 79%), pelvis (3/19, 16%), ribs (3/19, 16%) and femur (2/19, 11%). Ten patients (53%) had solitary, and nine patients (47%) had multiple, sites of bone metastases. In patients presenting with bone metastases at diagnosis compared with relapse, the mortality rate was 23% (3/13) and 50% (3/6), respectively. After receiving one line of chemotherapy, nine patients (47%) remained in remission not requiring further treatment, six (32%) required further chemotherapy due to subsequent relapse, three (16%) died after first‐line chemotherapy and one was lost to follow‐up. At the time of data collection and based on the last clinic follow‐up, six patients (32%) had died with a median (interquartile range, IQR) follow‐up of 11.5 (4.3, 24.8) months and 10 (53%) remained alive with a median (IQR) follow‐up of 26 (13.5, 48) months Three patients were lost to follow‐up. Of the known patients alive, eight (42%) remained in remission and two (11%) had recurrent disease requiring further treatment. Conclusion Although bone disease in germ cell cancer is rare, awareness of this condition is important and there is a need for prospective evaluation of patient characteristics, treatment approaches and survival outcome in this group of patients.

1052 Differentiation of microvessels and lymphatic vessels in non seminomatous testicular germ cell tumors using lymph specific markers: Morphologic characteristics and clinical implications

1052 Differentiation of microvessels and lymphatic vessels in non seminomatous testicular germ cell tumors using lymph specific markers: Morphologic characteristics and clinical implications

Laparoskopisch retroperitoneale Lymphadenektomie bei Low-volume-Keimzelltumoren nach Chemotherapie

Retroperitoneal lymph node dissection (RPLND) is the most appropriate method for the detection of residual tumor tissue and mature teratoma after chemotherapy in patients with advanced nonseminomatous (NSGCT) or seminomatous (SGCT) germ cell tumors in clinical stage II-III. Open surgical procedures are associated with higher morbidity rates and laparoscopic RPLND offers a minimally invasive procedure with equivalent oncological safety and low morbidity.In 39 patients laparoscopic RPLND (L-RPLND) after platinum-based chemotherapy for clinical stage IIa-III NSGCT was performed unilaterally as well as bilaterally by two surgeons. Patients with retroperitoneal residual tumor >1 cm and normalization of tumor markers after chemotherapy were included. Bilateral L-RPLND was performed with complete contralateral nerve sparing while the decision for ipsilateral nerve preservation was based on the volume of the residual mass in the respective standard field.The L-RPLND was completed in all patients without conversion. Median operation time was 248 min (range 95-397 min) and mean hospitalization time was 5 days (range 3-14 days). Furthermore, there was no difference in recurrence rate of the disease (p=0.45) between patients with unilateral or bilateral dissection. The postoperative ejaculatory function was normal in 37 out of 39 patients. The median follow-up period was 18.5 months (range 3-38 months) and 3 out of 39 patients developed recurrence (7.69 %).Post-chemotherapy L-RPLND is feasible with a lower complication rate and an adequate oncological safety and functional outcome. Due to the complexity of L-RPLND the procedure remains limited to institutions with extensive laparoscopic experience.

Clinical Significance of Amyloid Precursor Protein in Patients with Testicular Germ Cell Tumor

Introduction. The biological role of amyloid precursor protein (APP) is not well understood, especially in testicular germ cell tumors (TGCTs). Therefore, we aimed to investigate the immunoreactivity (IR) and expression of APP in TGCTs and evaluated its clinical relevance. Materials and Methods. We performed an analysis of immunohistochemistry and mRNA expression of APP in 64 testicular specimens and 21 snap-frozen samples obtained from 1985 to 2004. We then evaluated the association between APP expression and clinicopathological status in TGCTs. Results. Positive APP IR was observed in 9.8% (4/41) of seminomatous germ cell tumors (SGCTs) and 39.1% (9/23) of nonseminomatous germ cell tumors (NGCTs). NGCTs showed significantly more cases of positive IR (P = 0.00870) and a higher mRNA expression level compared with those of SGCTs (P = 0.0140). Positive APP IR was also significantly associated with α-fetoprotein (αFP) elevation (P = 0.00870) and venous invasion (P = 0.0414). Conclusion. We observed an elevated APP expression in TGCTs, especially in NGCTs. APP may be associated with a more aggressive cancer in TGCTs.

789O - The TAXIF II Protocol Final Results: A Phase II Trial of High-Dose Chemotherapy Supported by Haematopoietic Stem Cell Transplantation in Patients with Disseminated Germ-Cell Tumors Failing Chemotherapy and with Adverse Prognostic Factors

ABSTRACT Background High-dose chemotherapy (HDCT) has been shown to circumvent resistance in poor-prognosis germ cell tumors (GCT), mainly for patients whose relapses occur more than 4 weeks after cisplatin-based CT. Patients and methods This multicentric phase II trial was addressed to patients with poor-prognosis non-refractory GCTs. The main objectives were to determine the complete response rate and to monitor treatment-associated toxicities. Patients with adverse prognostic factors failing CT were to receive 2 cycles combining Epirubicin and Paclitaxel (EpiTax), followed by 3 consecutive HDCT [one using a Paclitaxel/Thiotepa association, 2 using the 5-day Ifosfamide-Carboplatine-Etoposide regimen]. Inclusion criteria included seminomatous GCT in relapse after 2 lines of CT, non-seminomatous GCT in relapse after 1 or 2 lines, partial remission after 1 line, primary mediastinal GCT in first relapse. Peripheral blood stem cells were collected after the EpiTax cycles. Results Between 09/2004 and 12/2007, 45 patients were included: 45 received 1 HDCT, 39 two HDCT, 29 patients received the complete protocol. Sixteen patients did not received the entire protocol, 8 (53%) for toxic side effects. Two patients (4.4%) died of toxicities, 17 (37.7%) of disease progression. For a median follow-up time of 26 months (4–51 m), the final overall response rate was 66,7% (CR, 20,6%). The median PFS was 16 months (95%CI, 9-NA) and the median OS was 32 months (95%CI, 32–49). The 2-year PFS was a plateau set up at 50% (95%CI, 32-67%) and the 2-year OS was 71% (95%CI, 52–83%). Conclusion The TAXIF II protocol was highly effective in non-refractory GCT patients failing CT. Disclosure F. Selle: consultancy for roche and Pharmamar. All other authors have declared no conflicts of interest.