Nonseminomatous Germ Cell Testicular Cancer Research Articles

Primary robotic RLPND for nonseminomatous germ cell testicular cancer: a two-center analysis of intermediate oncologic and safety outcomes.

To evaluate the intermediate-term oncologic outcomes and safety profile of the largest case series of primary robotic retroperitoneal lymphadenectomy for low-clinical-stage non-seminomatous germ cell testicular cancer. This was a two-center retrospective analysis of robotic RPLND cases for low-clinical-stage (stage I-IIB) non-seminomatous germ cell testicular cancer in the primary setting. Demographic, perioperative, operative and oncologic variables were collected between March 2008 and May 2019. Descriptive analyses were performed and presented as medians with interquartile ranges for continuous variables and frequency and proportions for categorical variables. A survival analysis of time to recurrence was performed using Cox proportional hazards model. Using logistic regression, risk factors for complications were analyzed. Both univariate and multivariate analyses were performed. A total of 58 patients (CS 1 = 56, CS IIA = 2, CS IIB = 0) were identified. The median follow-up was 47months and the 2-year recurrence-free survival rate was 91%. The five recurrences were all out of the performed dissection template (pelvis = 1 and lung = 4). Only five patients (29%) with occult metastasis underwent adjuvant chemotherapy. The median operative time was 319min [interquartile range (IQR) 276-355min], estimated blood loss was 100ml (IQR 75-200ml), node count was 26 (IQR 20-31), and length of stay 2 d (IQR 1-3days). There were 2 (3.3%) intraoperative complications, 19 (32.7%) 30-day postoperative complications to include 14 (24.1%) Clavien grade I, 4 (6.9%) Clavien grade II, 1 (1.7%) Clavien grade III and 0 Clavien grade IV complications. No statistical significance was found on multivariate or univariate analysis for survival analysis of time to recurrence and risk factors for complications. This study represents the largest case series of primary R-RPLND for the treatment of low-stage non-seminomatous germ cell tumors (NSGCT). With 47months of follow-up and a low rate of adjuvant chemotherapy, intermediate oncologic efficacy appears to be comparable to the gold standard open approach.

Decision analysis defining optimal management of clinical stage 1 high-risk nonseminomatous germ cell testicular cancer with lymphovascular invasion

BackgroundRisk of recurrent disease for men with clinical stage 1 high-risk nonseminomatous germ cell testicular cancer (CS1 NSGCT) with lymphovascular invasion (LVI) after orchiectomy is 50% and current treatment options (surveillance [S], retroperitoneal lymph node dissection [RPLND], or 1 cycle of BEP [BEP ×1]) are associated with a 99% disease specific survival, therefore practice patterns vary. We performed a decision analysis using updated data of long-term complications for men with CS1 NSGCT with LVI to quantify and assess relative treatment values. MethodsDecision analysis included previously defined utilities (via standard gamble) for posttreatment states of living from 0 (death from disease) to 1 (alive in perfect health) and updated morbidity probabilities. We quantified the values of S, RPLND, and BEP ×1 via the rollback method. Sensitivity analyses including a range of orchiectomy cure rates and utility values were performed. ResultsEstimated probabilities favoring treatment with RPLND (0.97) or BEP ×1 (0.97) were equivalent and superior to surveillance (0.88). Sensitivity analysis of orchiectomy cure rates (50%–100%) failed to find a cure rate that favored S over BEP ×1 or RPLND. Varying utility values for cure after S from 0.92 (previously defined utility) to 1 (perfect health), failed to find a viable utility state favoring S over BEP ×1 or RPLND. An orchiectomy cure rate of ≥82% would be required for S to equal treatment of either type. ConclusionsWe demonstrate that for surveillance to be superior to treatment with BEP ×1 or RPLND, the orchiectomy cure rate must be at least 82%, which is not expected in a patient population with high-risk CS1 NSGCT.

Late relapse in stage I of nonseminomatous germ cell testicular cancer on surveillance.

Primary aim was to assess relapse‑free survival (RFS) in patients with clinical stage I (CS I) of non-seminomatous germ cell testicular tumors (NSGCTT) undergoing surveillance after orchiectomy. The secondary aim was to examine differences in risk factors in patients with early relapse (ER 2 years) and very late relapse (VLR > 5 years). Cross-sectional study analyzed 25‑year single‑center experiences with 198 CS I NSGCTT patients according the time to relapse. RFS was 160/198 (80.8 %). Relapse occurred in 38 (19.2 %) patients after a median fol-low-up of 7.57 months, 33 (86.8 %) patients had ER after a median follow-up of 7.03 months and 5 patients had LR (13.2 %) after a median follow-up of 26.28 months. One patient (2.63 %) had VLR after follow-up > 5 years (7.17 years). Three relapsed patients died with metastatic disease after a mean follow-up of 5.1 years from the date of diagnosis. Another three patients died without cancer after a mean follow-up of two years. OS was 192/198 (97 %). Diagnosis and treatment of late relapsing NSGCTT patients should be performed in experienced centers only. Occurrence of LR is the reason for long-term monitoring of NSGCTT survivors (Tab. 1, Fig. 1, Ref. 14).

Clinical outcome of postchemotherapy retroperitoneal lymph node dissection and predicting retroperitoneal histology in advanced nonseminomatous germ cell tumours of the testis

Objective: To explore the clinical outcome of advanced testicular nonseminomatous germ cell cancer patients undergoing post chemotherapy retroperitoneal lymph node dissection (PC-RPLND), and to analyze the relevant prognostic factors of lymph node pathological. Methods: A total of 43 consecutive testicular nonseminomatous germ cell cancer patients underwent PC-RPLND between March 2001 and December 2014 in Department of Urology at Sun Yat-sen University Cancer Center were retrospectively reviewed. The average age of the patients was (29.0±11.5) years (ranging from 12 to 58 years). Before PC-RPLND, 22 patients were classified as phase Ⅱ, while 21 were phase Ⅲ. Primary tumor histology revealed seminomatous elements in 19 cases, embryonal cell carcinoma in 22 cases, yolk sac tumor in 13 cases, chorionic carcinoma in 3 cases, mature teratomatous elements in 11 and immature teratomatous elements in 2 cases. Patients were treated with cisplatin-based chemotherapy after orchectomy and then underwent surgical resection of retroperitoneal lymph nodes.After PC-RPLND, all patients underwent a periodic review including the blood routine, biochemistry routine and computed tomography or ultrasonograph of the chest, the abdomen and the pelvis. The association of pathological data with patient's clinic features and the correlations between molecular features detected with each other were assessed by the t test, χ(2) and Fisher's exact test. Multivariate logistic regression were used to assess prognostic factors. Results: The median operative time was 278 minutes (ranging from 50 to 715 minutes). Median blood loss was 425 ml (ranging from 50 to 5 000 ml). Eight patients received blood transfusion intra-operatively, 2 patients underwent adjunctive surgical procedures, 4 patients developed ileus and 4 had an ascites chylosus following PC-RPLND, 1 patient had a postoperative hyperthermia and retrograde ejaculation was present in 10 patients. The transverse diameter of the residual tumor in patients ranged from 0.8 to 18.2 cm. Necrosis, teratoma and viable germ cell tumors were found in 15, 17 and 11 of all patients. The median follow-up time was 46 months (ranging from 6 to 169 months). There were 39 patients had no tumor recurrence, 7 patients were found recurrence after PC-RPLND, 5 died of malignant germ cell tumor. The normal serum lactate dehydrogenase (LDH) level before chemotherapy (HR=25.811, 95%CI: 0.678 to 982.624, P=0.017) and relative changes more than 50% in retroperitoneal lymph node size (HR=0.016, 95%CI: 0 to 0.698, P=0.032) were statistically significant prognostic factors of the presence of necrosis. Conclusions: Since most residual masses are not sensitive to chemotherapy, PC-RPLND is still an essential part of the treatment of metastatic testicular nonseminomatous germ cell cancer. Patients with the normal serum LDH level before chemotherapy and a shrinkage of 50% or more in retroperitoneal mass have a considerably chance of having necrosis in the retroperitoneum resection. This may help to refine the selection of candidates for PC-RPLND.

Metastatic Testicular Choriocarcinoma Leading to Upper GI Bleed

Introduction: Testicular cancer is the most common neoplasia in men between the ages of 15 to 35 years. Choriocarcinoma represent less than 1% of testicular tumors. It usually characterized by early hematogenous spread to the lungs and brain (seen in 80% of the cases). Metastasis to the gastrointestinal tract is extremely rare. Most metastatic lesions in the GI tract are seen in the small bowel. Metastasis to the stomach is rarely seen and only reported in few case reports. Clinical Case: We present a 30 year-old African American male with a past medical history significant for non-seminomatous germ cell testicular cancer. Diagnosis was made via inguinal lymph node biopsy followed by right orchiectomy in April 2015. The patient was initially put on chemotherapy; however, he was not compliant with his treatment. In February 2016, he presented to the hospital with shortness of breath and chest pain. A CT angiography of the chest was done which showed multiple masses scattered in all lung fields. Those lesions were believed to be metastatic in nature. Laboraptory testing showed a human chorionic gonadotropin beta of 40,453 IU/L, LDH 258 IUnits/L and alfa-fetoprotein 8.9 ng/mL. His hospital stay was complicated with melena and a fall of his hemoglobin from a baseline of 12 to 7 gm/dL. He was given 2 units of packed red cells and started on pantoprazole drip. An EGD showed three erythematous friable nodules in the gastric body (figure 1). Biopsy results came back showing cytotrophoblast and syncytiotrophoblast which represent hallmark findings for metastatic choriocarcinoma (figure 2). The patient was offered salvage chemotherapy however he refused treatment and was discharged home.Figure 1Figure 2Discussion: Choriocarcinomas are the most aggressive and rapidly arising germ cell tumors. By the time they are diagnosed nearly half of the cases have already metastasized. Patients usually present with symptoms of hemorrhage in metastatic sites due to the high level of vascularization of those lesions. Gastrointestinal metastases from choriocarcinomas are very rare which account for 5% of all metastatic lesions. Of those less than 1% affect the stomach. The presenting symptoms of stomach metastases is melena and/or hematemesis along with anemia. Conclusion: Although extremely rare, gastric metastasis of choriocarcinoma should be kept in mind as part of the differential diagnosis for young patients with upper gastrointestinal bleeding.

Safety and Early Oncologic Effectiveness of Primary Robotic Retroperitoneal Lymph Node Dissection for Nonseminomatous Germ Cell Testicular Cancer

BackgroundPrimary robot-assisted retroperitoneal lymph node dissection (R-RPLND) has been studied as an alternative to open RPLND in single-institution series for patients with low-stage nonseminomatous germ cell tumors (NSGCT). ObjectiveTo evaluate a multicenter series of primary R-RPLND for low-stage NSGCT. Design, setting, and participantsBetween 2011 and 2015, 47 patients underwent primary R-RPLND at four centers for Clinical Stage (CS) I-IIA NSGCT. Surgical procedureR-RPLND was performed using the da Vinci surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Outcome measurements and statistical analysisData were collected regarding patient demographics, primary tumor characteristics, pathologic findings, and clinical outcomes. Results and limitationsForty-two patients (89%) were CS I and five (11%) were CS IIA. The median operative time was 235min (interquartile range [IQR]: 214–258min), estimated blood loss was 50ml (IQR: 50–100ml), node count was 26 (IQR: 18–32), and length of stay was 1 d. There were two intraoperative complications (4%), four early postoperative complications (9%), no late complications, and the rate of antegrade ejaculation was 100%. Of the eight patients (17%) with positive nodes (seven pN1and one pN2), five (62%) received adjuvant chemotherapy. The one recurrence was out of template in the pelvis after adjuvant chemotherapy (resected teratoma). The median follow-up was 16 mo and the 2-yr recurrence-free survival rate was 97% (95% confidence interval: 82–100%). Limitations include retrospective design and limited follow-up. ConclusionsOur multicenter experience supports R-RPLND as a potential option at experienced centers in select patients with low-stage NSGCT. Informal comparison to open and laparoscopic series suggests R-RPLND has an acceptably low morbidity profile, but oncologic efficacy evaluation requires further evaluation. Patient summaryWe examined outcomes after robot-assisted retroperitoneal lymph node dissection for patients with low-stage nonseminomatous testicular cancer with our data suggesting the robotic approach has acceptable morbidity and early oncologic outcomes.

Prostatic metastases from testicular nonseminomatous germ cell cancer: two case reports and a review of the literature.

Prostatic metastases from testicular germ cell tumors (TGCTs) are extremely uncommon. To the best of our knowledge, only five cases of prostatic metastases from seminoma have been reported in the literature. Conversely, no cases of metastases to the prostate from nonseminomatous germ cell tumors (NSGCT) have been previously reported. We present two patients who developed prostatic metastases 5 and 21 years after the initial diagnosis. The first case concerned a 28-year-old Caucasian man who underwent a right orchiectomy and right retroperitoneal lymph node dissection (RPLND) for a stage I NSGCT in 1999 and five years later was diagnosed with prostatic metastases. The second case concerned a 30-year-old man treated with a right orchiectomy and right RPLND for stage I NSGCT in 1985 who was diagnosed with prostatic metastases in 2006, 21 years after primary surgery. We reviewed the available literature on the topic. Prostatic metastases from TCGTs are highly unusual. Lower urinary tract symptoms in patients treated for previous testicular cancer require immediate clinical attention. However, because of their extreme rarity, specific clinical investigations to screen for possible prostatic involvement from TGCT should not be recommended.

Controversies in the Management of Clinical Stage I Nonseminomatous Germ Cell Testicular Cancer

Surveillance after orchiectomy alone has become popular in the management of clinical stage I of nonseminomatous germ cell testicular tumors (CSI NSGCTT). Efforts to identify patients at high-risk of relapse led to a search for risk factors in CSI NSGCTT. The aim of the current study was to analyze longterm experiences with risk-adapted therapeutic approaches (active surveillance and adjuvant chemotherapy). From 1/ 1992 to 2/ 2015, a total of 454 CSI NSGCTT patients were included in the study and stratified into two groups according to risk-adapted therapeutic approaches. In Group A (low- risk CSI NSGCTT), which consisted of 287 patients who underwent surveillance, relapse occurred in 48 (16.7%) patients with a median followup of 7.0 months. Six patients (2.1%) of this group died with a median followup of 34.3 months. In Group B (high-risk CSI NSGCTT), which consisted of 167 patients who were treated with adjuvant chemotherapy, relapse occurred in two (1.2%) patients with a median followup of 56.2 months. One patient (0.6%) died 139.4 months following orchiectomy. Statistically significant difference in progression free survival between these two groups was found, but no significant difference in overall survival.Key words: testicular cancer - surveillance - adjuvant chemotherapy - disease progression.

Low RBM3 protein expression correlates with clinical stage, prognostic classification and increased risk of treatment failure in testicular non-seminomatous germ cell cancer.

BackgroundExpression of the RNA-binding motif protein 3 (RBM3) has been shown to correlate with favourable clinicopathological parameters and prognosis in several cancer diseases. The aim of this study was to examine the expression and prognostic ability of RBM3 in patients with testicular non-seminomatous germ cell tumours (NSGCT).Patients and MethodsImmunohistochemical RBM3 expression was analysed in tissue microarrays with tumours from 206 patients. Chi-square test was applied to analyze associations between RBM3 expression and clinicopathological parameters. Kaplan-Meier analysis was used to assess the impact of RBM3 expression on cancer-specific survival (CSS) and failure-free survival (FFS). Cox regression proportional hazards models were used to estimate the relative risk for failure.ResultsIn the entire cohort, there was a significant association between clinical stage (p=0.044) and RBM3 expression. Weak RBM3 expression correlated with a significantly reduced FFS [79.3% versus 90.4% (p=0.019)] and CSS [87.5% versus 97.3% (p=0.047)]. For patients with metastatic disease (n = 88), significant associations were found between RBM3 expression and IGCCC group (p=0.007). The FFS was significantly inferior for patients with low tumour-specific RBM3 expression [59.3% versus 79.0% (p=0.013)], and this association remained significant in a multivariable model for patients with metastatic disease (HR=3.67; 95% CI 1.14, 11.89).ConclusionLow RBM3 expression is an independent predictor of treatment failure in metastatic NSGCT, in relation to the prognostic factors included in the International Germ Cell Consensus Classification (IGCCC). These findings suggest that RBM3 may be a potential biomarker for treatment stratification in patients with metastatic non-seminomatous germ cell tumours, and therefore merit further validation.

Bilateral testicular germ cell tumors in patients treated for clinical stage I non-seminoma within two risk-adapted SWENOTECA protocols

Background. A contralateral tumor occurs in 3.5–5% of men diagnosed with testicular germ cell cancer (TGCC). Biopsy of the contralateral testis may detect intratubular germ cell neoplasia ITGCNU, a precursor of TGCC. Biopsy of the contralateral testis to detect ITGCNU is controversial. If adjuvant chemotherapy (ACT) protects against bilateral cancer is debated.Material and methods. A total of 1003 patients with clinical stage I (CS I) non-seminomatous testicular germ cell cancer (NSGCT) were included in two prospective, population-based protocols. Fifteen patients were excluded. Treatment was either adjuvant chemotherapy (n = 494), or surveillance (n = 494). Contralateral testicular biopsy was recommended for all patients, but was performed only in 282 patients. In case of ITGCNU radiotherapy (RT) to 16 Gy was recommended.Results. During a follow-up of 8.3 years, 31 (3.6%) patients developed contralateral TGCC. ITGCNU was detected in 3.2% (9/282) of biopsied patients. The incidence of bilateral TGCC was similar following ACT, 2.5% (11/494), and surveillance, 3.4% (13/494), p = 0.41. Young age was a risk factor for metachronous TGCC (HR 0.93; 95% CI 0.88–0.99, p = 0.02). In total 2.2% (6/273) of patients without ITGCNU in the biopsy developed contralateral TGCC. One irradiated patient developed contralateral cancer, and one developed contralateral tumor before RT was given.Conclusion. ACT did not reduce the incidence of contralateral TGCC. Young patients had the highest risk of developing contralateral TGCC. The proportion of false negatives biopsies was higher than reported in earlier trials, but this may in part be related to patient selection, single biopsies and lack of mandatory immunohistochemistry.

Treatment outcome of patients with intermediate- and poor-prognosis metastatic testicular cancer in the 2000s: A multicenter experience in Japan.

397 Background: As a risk classification system of metastatic germ cell tumors, the International Germ Cell Consensus (IGCC) classification was proposed in 1997 and has received broad approval. We aimed to clarify the significance of the IGCC classification in the 2000s especially in intermediate and poor-prognosis patients in Japan. Methods: We analyzed 118 patients with intermediate- and poor-prognosis metastatic non-seminomatous germ cell testicular cancer treated at five university hospitals in Japan between 2000 and 2010. Data were collected on age, levels of serum AFP, HCG and LDH, lung metastases, spread to non-pulmonary visceral metastases (NPVM) and on treatment details (first, second and third-line chemotherapy and post-chemotherapy surgery) and survival data. Results: The median age at diagnosis was 31 years (range, 2-54 years). The median follow-up period of all patients was 57 months. Sixty-eight patients were classified as poor prognosis, having LDH elevation in 14 (21%), AFP in 13 (19%), HCG in 27 (40%), presence of NPVM in 44 (65%). As first line chemotherapy, 93 (79%) were treated by BEP (bleomycin, etoposide and cisplatin)-containing regimen. Of 118 patients, 75 (64%) received second-line chemotherapy, in which the most frequently used regimen was taxane-containing regimen, including TIP (paclitaxel, ifosfamide and cisplatin), TIN (paxlitaxel, ifosfamide and nedaplatin) and DIN (docetaxel, ifosfamide and nedaplatin). Third-line chemotherapy was carried out in 33 patients (28%). Eighty-nine patients (75%) underwent post-chemotherapy surgery. The 5-year overall survivals for intermediate (n=50) and poor (n=68) prognosis was 89% and 83% (P=0.23), respectively. In poor prognosis patients, patients with more than 2 poor-prognostic factors had significantly worse survival than those with only one prognostic factor (72% vs 91%, P=0.01). Conclusions: There was a trend of increase in survival for any risk groups and, in particular, large increase in survival for patients with a poor prognosis. Further classification of poor-prognosis patients into two subgroups has a potential to identify a patient group with very poor-prognosis.

Management of patients with clinical stage I nonseminomatous germ cell testicular cancer: Active surveillance versus adjuvant chemotherapy - single-centre experience.

Surveillance after orchiectomy alone has become popular in the management of clinical stage I nonseminomatous germ cell testicular tumors (CSI NSGCTT). Efforts to identify patients at high risk of disease progression led to a search for risk factors in CSI NSGCTT. The aim of the present study was to analyse single-centre experience with risk-adapted therapeutic approaches (active surveillance versus adjuvant chemotherapy). From 1/1992 to 12/2013 a total of 431 CSI NSGCTT patients were included in the study and stratified into two groups according to risk-adapted therapeutic approaches. Group A (low-risk CSI NSGCTT) consisted of 276 patients who underwent active surveillance, progression of disease occurred in 46 (16.7%) patients with a median follow-up of 7.2 months. Six patients (2.2 %) of this group died with a median follow-up of 34.3 months. Group B (high-risk CSI NSGCTT) consisted of 155 patients who were treated with adjuvant chemotherapy, disease progression occurred in two (1.3 %) of them with a median follow-up of 56.2 months. One patient (0.6 %) died 139.4 months following orchiectomy. Overall survival rate of all CSI NSGCTT patients in both groups was 424/431 (98.4 %) with median follow-up of 130.4 months following orchiectomy. Surveillance policy is recommended only in patients with low-risk CSI NSGCTT. testicular cancer, surveillance, adjuvant chemotherapy, disease progression.

Low Rbm3 Protein Expression Correlates with Clinical Stage, Prognostic Index and Increased Risk of Treatment Failure in Testicular Non-Seminomatous Germ Cell Cancer

ABSTRACT Aim: Expression of the RNA-binding motif protein 3 (RBM3) has in previous studies been shown to correlate with favourable clinicopathological parameters and prognosis in a number of cancer forms. The aim of this study was to examine the expression and prognostic ability of RBM3 in patients with non-seminomatous germ cell tumours (NSGCT). Methods: Immunohistochemical RBM3 expression was analysed in tissue microarrays with tumours from 206 patients with NSGCT. Chi-square test was applied to analyze associations between RBM3 expression and clinicopathological parameters. Kaplan-Meier analysis was used to assess the impact of RBM3 expression on cancer-specific survival (CSS) and progression-free survival (PFS). Cox regression proportional hazards models were used to estimate the relative risk for progression in both uni- and multivariable analysis. Results: In the entire cohort, there was a significant association between clinical stage (p=0.044) and RBM3 expression. Low RBM3 expression correlated with a significantly reduced PFS [67.7% versus 87.8% (p=0.001)] and CSS [87.5% versus 97.3% (p=0.047)]. For patients with metastatic disease (n=88), significant associations were found between RBM3 expression and IGCCC prognostic index (p=0.007), combined tumor marker status (p=0.001) and HCG level (p=0.010). The PFS was significantly inferior for patients with low tumour-specific RBM3 expression [40.0% versus 73.0% (p=0.002)], and this association remained significant in a multivariable model (HR=2.98; 95% CI 1.14, 7.75). Conclusions: Low RBM3 expression is significantly associated with a worse IGCCC-prognostic index and is an independent predictor of disease progression in metastatic NSGCT. These findings suggest that RBM3 may be a potential biomarker for treatment stratification in patients with metastatic non-seminomatous germ cell tumours, and therefore merit further validation. Disclosure: All authors have declared no conflicts of interest.

Nodal, pulmonary and pleural gliomatosis in a 42-year-old-male with non-seminomatous testicular germ cell cancer

HistopathologyVolume 65, Issue 1 p. 142-143 Correspondence Nodal, pulmonary and pleural gliomatosis in a 42-year-old-male with non-seminomatous testicular germ cell cancer Christoph Oing, Christoph Oing Department of Oncology, Hematology and Bone Marrow Transplantation, University Medical Center Eppendorf, Hamburg, GermanySearch for more papers by this authorRegina Wagner, Regina Wagner Institute of Pathology, University Medical Center Eppendorf, Hamburg, GermanySearch for more papers by this authorCarsten Bokemeyer, Carsten Bokemeyer Department of Oncology, Hematology and Bone Marrow Transplantation, University Medical Center Eppendorf, Hamburg, GermanySearch for more papers by this authorFriedemann Honecker, Friedemann Honecker Department of Oncology, Hematology and Bone Marrow Transplantation, University Medical Center Eppendorf, Hamburg, Germany Tumor and Breast Center ZeTuP, St Gallen, SwitzerlandSearch for more papers by this author Christoph Oing, Christoph Oing Department of Oncology, Hematology and Bone Marrow Transplantation, University Medical Center Eppendorf, Hamburg, GermanySearch for more papers by this authorRegina Wagner, Regina Wagner Institute of Pathology, University Medical Center Eppendorf, Hamburg, GermanySearch for more papers by this authorCarsten Bokemeyer, Carsten Bokemeyer Department of Oncology, Hematology and Bone Marrow Transplantation, University Medical Center Eppendorf, Hamburg, GermanySearch for more papers by this authorFriedemann Honecker, Friedemann Honecker Department of Oncology, Hematology and Bone Marrow Transplantation, University Medical Center Eppendorf, Hamburg, Germany Tumor and Breast Center ZeTuP, St Gallen, SwitzerlandSearch for more papers by this author First published: 20 January 2014 https://doi.org/10.1111/his.12374Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume65, Issue1July 2014Pages 142-143 RelatedInformation

Prostatic Metastases from Testicular Nonseminomatous Germ Cell Cancer: Two Case Reports and a Review of the Literature

Prostatic metastases from testicular germ cell tumors (TGCTs) are extremely uncommon. To the best of our knowledge, only five cases of prostatic metastases from seminoma have been reported in the literature. Conversely, no cases of metastases to the prostate from nonseminomatous germ cell tumors (NSGCT) have been previously reported. We present two patients who developed prostatic metastases 5 and 21 years after the initial diagnosis. The first case concerned a 28-year-old Caucasian man who underwent a right orchiectomy and right retroperitoneal lymph node dissection (RPLND) for a stage I NSGCT in 1999 and five years later was diagnosed with prostatic metastases. The second case concerned a 30-year-old man treated with a right orchiectomy and right RPLND for stage I NSGCT in 1985 who was diagnosed with prostatic metastases in 2006, 21 years after primary surgery. We reviewed the available literature on the topic. Prostatic metastases from TCGTs are highly unusual. Lower urinary tract symptoms in patients treated for previous testicular cancer require immediate clinical attention. However, because of their extreme rarity, specific clinical investigations to screen for possible prostatic involvement from TGCT should not be recommended.

Clinical outcomes in patients with stage I non-seminomatous germ cell cancer

This study assesses the long-term outcomes in Han Chinese patients with clinical stage I non-seminomatous germ cell testicular cancer (CSI NSGCT) treated with surveillance, retroperitoneal lymph node dissection (RPLND) and adjuvant chemotherapy. We retrospectively evaluated 89 patients with a mean age of 26.5 years. After orchiectomy, 37 patients were treated with surveillance, 34 underwent RPLND and 18 were managed with chemotherapy. The overall survival rate, the recurrence-free survival rate and the risk factors were evaluated. The median follow-up length was 92 months (range: 6-149 months). Thirteen of the 89 patients (14.6%) had relapses, and one died by the evaluation date. The overall survival rate was 98.9%. The cumulative 4-year recurrence-free rates were 80.2%, 92.0% and 100% for the surveillance, RPLND and chemotherapy groups, respectively. The disease-free period tended to be briefer in patients with a history of cryptorchidism and those with stage Is. Therefore, surveillance, RPLND and adjuvant chemotherapy might be reliable strategies in compliant patients with CSI NSGCT. Surveillance should be recommended for patients with the lowest recurrence rate, especially those without lymphovascular invasion. This study might aid the establishment of a standard therapy for CSI NSGCT in China.

Commentary on “Survival after resection for metastatic testicular nonseminomatous germ cell cancer to the lung or mediastinum.” Kenneth A. Kesler, a Laura E. Kruter, a Susan M. Perkins, b Karen M. Rieger, a Katherine J. Sullivan, a Matthew L. Runyan, a John W. Brown, a Lawrence H. Einhorn, caDepartment of Surgery, Cardiothoracic Division and Medicine, Indiana University Melvin and Bren

Commentary on “Survival after resection for metastatic testicular nonseminomatous germ cell cancer to the lung or mediastinum.” Kenneth A. Kesler, a Laura E. Kruter, a Susan M. Perkins, b Karen M. Rieger, a Katherine J. Sullivan, a Matthew L. Runyan, a John W. Brown, a Lawrence H. Einhorn, caDepartment of Surgery, Cardiothoracic Division and Medicine, Indiana University Melvin and Bren

Clinical Impact of Residual Extraretroperitoneal Masses in Patients With Advanced Nonseminomatous Germ Cell Testicular Cancer

Integration of platinum-based chemotherapy and surgical resection of residual masses is essential in the management of advanced nonseminomatous germ cell tumors (NSGCT). We reviewed our institutional experience in patients undergoing resection of extraretroperitoneal (ERP) residual masses after chemotherapy to assess its impact on cancer progression and survival. Between 1989 and 2003, 532 patients with advanced NSGCT underwent postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) with a median follow-up of 41 months. Survival probabilities were estimated by the Kaplan-Meier method. Cox proportional hazards regression analysis was used to determine the prognostic significance of risk factors for progression and survival. Of 532 patients, 402 (76%) underwent PC-RPLND alone, and 130 (24%) underwent resection of ERP residual disease concurrently or in a staged fashion within 6 weeks. Concordance between retroperitoneal (RP) and ERP sites of disease was 83% in the presence of fibrosis, 42% for teratoma, and 47% for viable NSGCT. Overall, 34% of patients undergoing resection of ERP residual disease had either teratoma or viable disease on final pathology. Five-year probability of freedom from progression was 74% (95% CI 65%, 82%) and disease-specific survival was 84% (95% CI 75%, 89%). On multivariable analysis the histologic findings at the ERP site were significant predictors of disease progression, independent of the RP findings. Our data suggest that teratoma or viable NSGCT is present in approximately one-third of patients undergoing resection of residual ERP disease. The presence of residual ERP teratoma and viable NSGCT predicts for cancer progression independent of RP histology.

High-dose chemotherapy with autologous stem cell support in patients with metastatic non-seminomatous testicular cancer – a report from the Swedish Norwegian Testicular Cancer Group (SWENOTECA)

Background. The SWENOTECA IV protocol from 1995 is a prospective population-based study in metastatic non-seminomatous germ cell testicular cancer (NSGCT), designed for early identification of patients with poor response to standard cisplatin-based chemotherapy. A slow tumor marker decline (HCG T½ > 3 days, AFP T½ > 7 days) after BEP or BEP plus ifosfamide was regarded as poor response. The aim of this study was to present survival and toxicity data for patients treated with high-dose chemotherapy (HDCT) within the SWENOTECA IV cancer care program. Material and methods. In total 882 adult men diagnosed with metastatic NSGCT between July 1995 and June 2007 in Sweden and Norway (except one center) were included in SWENOTECA IV and treated accordingly. Among these, 55 men (6.2%) were treated with HDCT according to three different indications in the protocol: A) poor response to standard-dose intensified chemotherapy (BEP plus ifosfamide); B) vital cancer at surgery after intensified chemotherapy; and C) selected relapses after previous chemotherapy. In situation A and C two HDCT cycles and in situation B one HDCT cycle was recommended. Situation A was the reason for HDCT in 36 patients, B in seven and C in 12 patients. The first HDCT cycle consisted of carboplatin 28 × (GFR + 25) mg, cyclofosfamide 6000 mg/m2 and etoposide 1750 mg/m2, administered over four days. In cycle two, etoposide was replaced by tiotepa 480 mg/m2. Results. After a median follow-up of 7.5 years, overall survival was 72%, 100% and 58%, while failure-free survival was 64%, 71% and 42% in situation A, B and C, respectively. Three patients (5.5%) died during HDCT (renal failure or intracerebral hemorrhage). Nephrotoxicity was the most common non-hematological grade 4 toxicity (n = 5, 9%). Conclusion. The population-based SWENOTECA strategy, selecting patients who do not respond adequately to primary standard-dose chemotherapy for immediate treatment intensification with HDCT, is feasible and might be advantageous.

Socio-economic inequalities in testicular cancer survival within two clinical studies

Background: Testicular cancer is the most common cancer in men under 35 years of age, and has the highest survival for adult male malignancies. Despite the fact that survival is very high, there is evidence that survival differs between socio-economic groups. Methods: We analysed survival patterns for 1606 testicular cancer patients diagnosed during 1984–2001 and recruited to one of two clinical studies. The first was a surveillance study to determine relapse-free survival after orchidectomy in 865 patients with stage I nonseminomatous germ-cell testicular cancer diagnosed during 1984–1991 (TE04). The second study was a trial in which 1174 men with stage I seminomatous germ-cell tumours were randomised to receive radiotherapy or one injection of carboplatin between 1996 and 2001 (TE19). The number of men available for analysis from these two studies was 578 and 1028, respectively. We followed these patients up for their vital status, and assigned them an ecological measure of deprivation. Crude and relative survival were estimated at 5 and 10 years by socio-economic deprivation. Results: No significant socio-economic gradient was seen: 1.3% (95% CI −0.3% to 3.1%) at 5 years and 2.1% (95% CI −0.5% to 4.7%) at 10 years. Conclusion: We conclude that, given equal treatment at a given stage of disease, survival from testicular cancer does not depend on socio-economic status. This suggests that the socio-economic gradient in testicular cancer survival in the general population is more likely to be attributable to health care system factors than to personal or socio-economic factors in the men themselves.