Testis Cancer Patients Research Articles

Editorial Comment to: "Survival of stage III non-seminoma testis cancer patients versus simulated controls, according to race/ethnicity".

Editorial Comment to: "Survival of stage III non-seminoma testis cancer patients versus simulated controls, according to race/ethnicity".

Survival of stage III non-seminoma testis cancer patients versus simulated controls, according to race/ethnicity.

It is unknown whether 5-year overall survival (OS) differs and to what extent between the American Joint Committee on Cancer stage III non-seminoma testicular germ cell tumor (NS-TGCT) patients and simulated age-matched male population-based controls, according to race/ethnicity groups. We identified newly diagnosed (2004-2014) stage III NS-TGCT patients within the Surveillance Epidemiology and End Results database 2004-2019. For each case, we simulated an age-matched male control (Monte Carlo simulation), relying on Social Security Administration (SSA) Life Tables with 5 years of follow-up. We compared OS rates between stage III NS-TGCT patients and simulated age-matched male population-based controls, according to race/ethnicity groups (Caucasian, Hispanic, Asian/Pacific Islander and African American). Both, cancer-specific mortality (CSM) and other-cause mortality (OCM) were computed. Of 2054 stage III NS-TGCT patients, 60% were Caucasians versus 33% Hispanics versus 4% Asians/Pacific Islanders versus 3% African Americans. The 5-year OS difference between stage III NS-TGCT patients versus simulated age-matched male population-based controls was highest in Asians/Pacific Islanders (64 vs. 99%, Δ = 35%), followed by African Americans (66 vs. 97%, Δ = 31%), Hispanics (72 vs. 99%, Δ = 27%), and Caucasians (76 vs. 98%, Δ = 22%). The 5-year CSM rate was highest in Asians/Pacific Islanders (32%), followed by African Americans (26%), Hispanics (25%), and Caucasians (20%). The 5-year OCM rate was highest in African Americans (8%), followed by Caucasians (4%), Asians/Pacific Islanders (4%), and Hispanics (2%). Relative to SSA Life Tables, the highest 5-year OS disadvantage applied to stage III NS-TGCT Asian/Pacific Islander race/ethnicity group, followed by African American, Hispanic and Caucasian, in that order.

Survival differences in non-seminoma testis cancer patients according to race/ethnicity

BackgroundHistoric evidence suggests that non-Caucasian race/ethnicity predisposes to higher testis cancer-specific mortality (CSM) in non-seminoma. However, it is unknown, whether higher CSM in non-Caucasians applies to Hispanics or Asians or African-Americans, or all of the above groups. In contemporary patients, we tested whether CSM is higher in these select non-Caucasian groups than in Caucasians, in overall and in stage-specific comparisons: stage I vs. stage II vs. stage III. MethodsThe Surveillance, Epidemiology, and End Results (SEER) database (2004 −2019) was used. Kaplan-Meier plots and multivariable Cox regression models tested the effect of race/ethnicity on CSM after stratification for stage (I vs. II vs. III) and adjustment for prognosis groups in stage III. ResultsIn all 13,515 non-seminoma patients, CSM in non-Caucasians was invariably higher than in Caucasians. In stage-specific analyses, race/ethnicity represented an independent predictor of CSM in Hispanics in stage I (HR 1.8, p = 0.004), stage II (HR 2.2, p = 0.007) and stage III (HR 1.4, p < 0.001); in African-Americans in stage I (HR 3.2; p = 0.007) and stage III (HR 1.5; p = 0.042); and in Asians in only stage III (HR 1.6, p = 0.01). ConclusionsIn general, CSM is higher in non-Caucasian non-seminoma patients. However, the CSM increase differs according to non-Caucasian race/ethnicity groups. Specifically, higher CSM applies to all stages of non-seminoma in Hispanics, to stages I and III in African-Americans and only to stage III in Asians. These differences are important for individual patient management, as well as for design of prospective trials.

A population-based validation of the IGCCCG Update Consortium for survival in metastatic non-seminoma testis cancer.

In 2021, the International Germ Cell Cancer Collaborative Group (IGCCCG) Update Consortium reported improved overall survival (OS) rates in a modern cohort of metastatic non-seminoma testis cancer patients within each of the IGCCCG prognosis groups (96% in good vs. 89% in intermediate vs. 67% in poor), compared to the previous IGCCCG publication (92% in good vs. 80% in intermediate vs. 48% in poor). We hypothesized that a similar survival improvement may apply to a contemporary North-American population-based cohort of non-seminoma testis cancer patients. The Surveillance, Epidemiology, and End Results (SEER) database (2010-2018) was used. Kaplan-Meier plots and multivariable Cox regression models tested the effect of IGCCCG prognosis groups on overall mortality (OM). Of 1672 surgically treated metastatic non-seminoma patients, 778 (47%) exhibited good vs. 251 (15%) intermediate vs. 643 (38%) poor prognosis. In the overall cohort, five-year OS rate was 94% for good prognosis vs. 87% for intermediate prognosis vs. 65% for poor prognosis. In multivariable Cox regression models predicting OM, intermediate (Hazard ratio [HR] 2.4, 95% confidence interval [CI] 1.4-3.9, P<0.001) and poor prognosis group (HR 6.6, 95% CI 1.0-1.0, P<0.001) were independent predictors of higher OM, relative to good prognosis group. The survival improvement reported by the IGCCCG Update Consortium is also operational in non-seminoma testis cancer patients within the most contemporary SEER database. This observation indicates that the survival improvement is not only applicable to centres of excellence, but also applies to other institutions at large.

Conditional survival of stage III non-seminoma testis cancer patients

PurposeIn many primaries other than non-seminoma testis cancer, the risk of death due to cancer decreases with increasing disease-free interval duration after initial diagnosis and treatment. This effect is known as conditional survival and is relatively unexplored in stage III non-seminoma patients, where it may matter most in clinical decision-making. We examined the effect of disease-free interval duration on overall survival in stage III non-seminoma patients. Materials and MethodsWithin the Surveillance, Epidemiology, and End Results Database (2004–2018), stage III non-seminoma patients were identified. Multivariable Cox regression analyses and conditional survival models were applied. ResultsOf 2,092 surgically treated stage III non-seminoma patients, 385 (18%) exhibited good vs. 558 (27%) intermediate vs. 1,149 (55%) poor prognosis. In multivariable Cox regression models, poor prognosis group independently predicted overall mortality (HR 3.3, P < 0.001). In conditional survival analyses based on 36 months’ disease-free interval duration, 5-year overall survival estimates were as follows: good prognosis patients 96 vs. 89% at initial diagnosis without accounting for disease-free interval duration (Δ=+7); intermediate prognosis patients 94 vs. 85% at initial diagnosis without accounting for disease-free interval duration (Δ=+9); poor prognosis patients 94 vs. 65% at initial diagnosis without accounting for disease-free interval duration (Δ=+29). ConclusionsConditional survival estimates based on 36 months’ disease-free interval duration provide a more accurate and more optimistic outlook for stage III non-seminoma patients than predictions defined at initial diagnosis, without accounting for disease-free interval duration.

Nerve-sparing technique in RPLND for testicular cancer.

The management of testicular cancer has evolved over time with multimodal therapy. Retroperitoneal lymph node dissection (RPLND), which is a complex and potentially morbid treatment option, remains the mainstay in surgical treatment. This article reviews the surgical template, approach and anatomical considerations with regards to nerve spare in RPLND. The standard full bilateral RPLND template has evolved over time to include the area between the renal hilum, bifurcation of the common iliac vessels, and the ureters. Morbidity with regards to ejaculatory dysfunction has led to further refinements in this procedure. Advancements in anatomical understanding of the retroperitoneal structures and their relationship to the sympathetic chain and hypogastric plexus has allowed for modification of surgical templates. Further refinements in surgical nerve sparing techniques have improved functional outcomes without sacrificing oncological outcomes. Finally, extraperitoneal access to the retroperitoneum and minimally invasive platforms have been implemented to further reduce morbidity. RPLND requires strict adherence to oncological surgical principles regardless of template, approach and technique. Contemporary evidence shows that outcomes are best for advanced testis cancer patients when managed at high volume tertiary care facilities with surgical expertise and access to multidisciplinary care.

Cadmium and lead implication in testis cancer; is there a connection?

Testis cancer (TC) is the most common malignancy of young men. Current evidence from studies, alongside genetics and hormonal status, suggests a significant role of toxic metals, cadmium (Cd) and lead (Pb), in the origin and development of TC. Besides oxidative stress and endocrine disruption, interaction with bioelements is one of the critical mechanisms of Cd and Pb toxicity and malign transformation. This study aimed to investigate metal levels in blood, healthy, and tumor testis tissue and to reveal hormone, oxidative status, and bioelements levels in patients with TC. The study enrolled 52 patients with TC and 61 healthy volunteers. Toxic metals and bioelements levels were analyzed by atomic absorption spectrophotometry (AAS) while electrochemiluminescence immunoassay (ECLIA) and spectrophotometry methods were used for hormone and oxidative parameters evaluation. Significantly higher blood Cd levels were depicted in TC cohort. Furthermore, blood Cd elevation was associated with a 1.98 higher probability of TC developing. However, a metal concentration between healthy and tumor testis tissue did not differ significantly. Lower levels of estradiol and testosterone, established in a cohort of TC patients, followed the significant role of hormones in TC development. At the same time, ischemia-modified albumin (IMA) has been recognized as a parameter with very good accuracy as a potential diagnostic marker for TC. The study revealed different distribution patterns of copper (Cu) and zinc (Zn) in the three compartments of the patients, as well significant correlation between essential metals Cu/Zn and toxic metals Cd/Pb indicating metal-metal interactions as pivotal mechanisms of metals toxicity.

MP33-17 EXAMINING SURVIVAL OUTCOMES BY RACE AND ETHNICITY IN TESTIS CANCER: A REVERSE HISPANIC PARADOX?

You have accessJournal of UrologyCME1 Apr 2023MP33-17 EXAMINING SURVIVAL OUTCOMES BY RACE AND ETHNICITY IN TESTIS CANCER: A REVERSE HISPANIC PARADOX? Michael Rezaee, Maximilian Pallauf, Pranjal Agrawal, Roy Elias, Sean Fletcher, Yasser Ged, and Nirmish Singla Michael RezaeeMichael Rezaee More articles by this author , Maximilian PallaufMaximilian Pallauf More articles by this author , Pranjal AgrawalPranjal Agrawal More articles by this author , Roy EliasRoy Elias More articles by this author , Sean FletcherSean Fletcher More articles by this author , Yasser GedYasser Ged More articles by this author , and Nirmish SinglaNirmish Singla More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003266.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The incidence of testis cancer among Hispanic men in the United States is increasing. Prior research has demonstrated that Hispanic patients exhibit a survival benefit for many medical conditions, a phenomenon known as the “Hispanic Paradox.” However, this paradox may not extend to testis cancer. We sought to examine survival outcomes in testis cancer by race using a large national sample. METHODS: A population-based retrospective cohort study of testis cancer patients was performed using Surveillance, Epidemiology, and End Results (SEER) data for the years 2000 through 2019. Cox proportional hazards models were used to examine the relationship between race/ethnicity and testis cancer-specific survival, both overall and by histologic type (seminoma vs. nonseminomatous germ cell tumors [NSGCT]). All models were adjusted for age, stage, receipt of postoperative radiation or chemotherapy, year of diagnosis, income, marital status, and rural status. RESULTS: The final analytic cohort consisted of 18,600 patients, of whom 66.8% were Non-Hispanic White (NHW), 2.2% Non-Hispanic Black (NHB), 24.9% Hispanic (all races), and 6.1% Non-Hispanic Asian or Pacific Islander (API). Median follow up was 92 months. Death from testis cancer occurred in 2.7% of patients. A greater proportion of Hispanics were diagnosed at an age less than 30 years (54.4%) and with initial metastatic disease (15.2%) compared to other groups. Hispanics experienced significantly worse cancer-specific survival (hazard ratio [HR] = 1.8, 95% CI: 1.5-2.2) compared to NHW patients overall (Figure 1). When stratified by tumor type, cancer-specific survival was significantly worse for Hispanics (HR = 1.8, 95% CI: 1.4-2.2) and API’s (HR = 1.6, 95% CI: 1.1-2.5) with NSGCTs. No difference was observed in cancer-specific survival by race/ethnicity for seminoma patients, however. CONCLUSIONS: Contrary to the Hispanic paradox reported across many medical conditions, cancer-specific survival is significantly worse for Hispanic men with testis cancer, particularly among those with NSGCT tumors. Future investigation of both public health and biological factors is needed to identify actionable drivers for this observed difference. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e457 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Rezaee More articles by this author Maximilian Pallauf More articles by this author Pranjal Agrawal More articles by this author Roy Elias More articles by this author Sean Fletcher More articles by this author Yasser Ged More articles by this author Nirmish Singla More articles by this author Expand All Advertisement PDF downloadLoading ...

Contemporary conditional cancer-specific survival rates in stage III non-seminoma testis cancer patients: A population-based analysis

Contemporary conditional cancer-specific survival rates in stage III non-seminoma testis cancer patients: A population-based analysis

Minimally invasive retroperitoneal lymph node dissection for men with testis cancer: a retrospective cohort study of safety and feasibility

To describe the perioperative safety, functional and immediate post-operative oncological outcomes of minimally invasive RPLND (miRPLND) for testis cancer. We performed a retrospective multi-centre cohort study on testis cancer patients treated with miRPLND from 16 institutions in eight countries. We measured clinician-reported outcomes stratified by indication. We performed logistic regression to identify predictors for maintained postoperative ejaculatory function. Data for 457 men undergoing miRPLND were studied. miRPLND comprised laparoscopic (n = 56) or robotic (n = 401) miRPLND. Indications included pre-chemotherapy in 305 and post-chemotherapy in 152 men. The median retroperitoneal mass size was 32mm and operative time 270min. Intraoperative complications occurred in 20 (4%) and postoperative complications in 26 (6%). In multivariable regression, nerve sparing, and template resection improved ejaculatory function significantly (template vs bilateral resection [odds ratio (OR) 19.4, 95% confidence interval (CI) 6.5-75.6], nerve sparing vs non-nerve sparing [OR 5.9, 95% CI 2.3-16.1]). In 91 men treated with primary RPLND, nerve sparing and template resection, normal postoperative ejaculation was reported in 96%. During a median follow-up of 33months, relapse was detected in 39 (9%) of which one with port site (< 1%), one with peritoneal recurrence and 10 (2%) with retroperitoneum recurrences. The low proportion of complications or peritoneal recurrences and high proportion of men with normal postoperative ejaculatory function supports further miRPLND studies.

Sentinel lymph node mapping in post chemotherapy nonseminoma testicular cancer patients undergoing retroperitoneal lymph node dissection: A series of nine cases.

Objective(s):Testicular germ cell cancers are the most common solid malignancy among young men at the age ranging between 14 and 35 years. In this study, we evaluated the feasibility of sentinel lymph node mapping using intraoperative injection of radiotracer in nonseminomatous testicular cancer patients with history of orchiectomy who were candidate for retroperitoneal lymph node dissection (RPLND) in post-chemotherapy setting.Methods:Nine consecutive cases were included in the study. Technetium-99m-labelled phytate was injected in two divided doses in the stump of the spermatic cord, through transabdominal approach. A hand-held gamma probe was used for radio-guided retroperitoneal sentinel lymph node detection intraoperatively and confirming the location of the sentinel lymph nodes.Results: Detection rate and the false negative rate were estimated as the main indices. The detection rate was 6/9 (66%) and the false negative rate was 0/2 (0%). Location of the dissected sentinel lymph nodes were interaortocaval (2 patients), internal iliac (1 patient), external iliac (1 patient), common iliac (2 patients), and paraaortic (1 patient).Conclusion:Sentinel lymph node mapping technique seems to be feasible and promising in post chemotherapy non-seminoma testis cancer patients who are candidate for RPLND; however, further larger studies are needed to increase and standardize the detection rate.

Intricacies of retroperitoneal lymph node dissection for testis cancer.

Retroperitoneal lymph node dissection (RPLND) and retroperitoneal tumor resection for germ cell cancer are complex operations requiring experience and expertise in surgical techniques necessary to achieve complete resection while minimizing morbidity. This article reviews the intricacies of RPLND for testis cancer. Surgical management of advanced testis cancer begins with an intimate understanding of retroperitoneal anatomy and the various techniques necessary to safely extirpate tumors. Preoperatively patients should undergo comprehensive counseling and obtain up-to-date imaging along with tumor markers to assist in surgical planning and evaluation of extraretroperitoneal (ERP) disease. Surgeons must be well versed in nerve-sparing techniques to maintain ejaculatory function. Newer techniques using a midline extraperitoneal technique minimizes morbidity and length of hospital stay. Special consideration should be given to the possibility of encountering ERP disease in advanced germ cell tumors, with management of these cases in tertiary care centers with multidisciplinary teams. The perioperative care of the testis cancer patient undergoing RPLND is complex. The goal is to achieve complete resection to render patients disease free while minimizing surgical and long-term morbidity. Advanced testis cancer patients should be managed at tertiary care facilities with surgical expertise and access to multidisciplinary care.

The effect of primary urological cancers on survival in men with secondary prostate cancer.

To test the effect of urological primary cancers (bladder, kidney, testis, upper tract, penile, urethral) on overall mortality (OM) after secondary prostate cancer (PCa). Within the Surveillance, Epidemiology and End Results (SEER) database, patients with urological primary cancers and concomitant secondary PCa (diagnosed 2004-2016) were identified and were matched in 1:4 fashion with primary PCa controls. OM was compared between secondary and primary PCa patients and stratified according to primary urological cancer type, as well as to time interval between primary urological cancer versus secondary PCa diagnoses. We identified 5,987 patients with primary urological and secondary PCa (bladder, n = 3,287; kidney, n = 2,127; testis, n = 391; upper tract, n = 125; penile, n = 47; urethral, n = 10) versus 531,732 primary PCa patients. Except for small proportions of Gleason grade group and age at diagnosis, PCa characteristics between secondary and primary PCa were comparable. Conversely, proportions of secondary PCa patients which received radical prostatectomy were smaller (29.0 vs. 33.5%), while no local treatment rates were higher (34.2 vs. 26.3%). After 1:4 matching, secondary PCa patients exhibited worse OM than primary PCa patients, except for primary testis cancer. Here, no OM differences were recorded. Finally, subgroup analyses showed that the survival disadvantage of secondary PCa patients decreased with longer time interval since primary cancer diagnosis. After detailed matching for PCa characteristics, secondary PCa patients exhibit worse survival, except for testis cancer patients. The survival disadvantage is attenuated, when secondary PCa diagnosis is made after longer time interval, since primary urological cancer diagnosis.

Utility of Serum miR-371a-3p in Predicting Relapse on Surveillance in Patients with Clinical Stage I Testicular Germ Cell Cancer

BackgroundOptimal management of clinical stage I (CSI) testicular cancer is controversial due to lack of robust prognostic factors; miRNA-371a-3p holds promise as a biomarker, although its clinical utility for identifying patients at risk of relapse is unknown. ObjectiveTo explore the association between serum miR-371a-3p and CSI surveillance relapse. Design, setting, and participantsSerial banked sera from 151 CSI (101 seminomas and 50 nonseminomatous germ cell tumors [NSGCTs]) samples from our Princess Margaret active surveillance cohort were tested. Outcome measurements and statistical analysisUsing the ampTSmiR test, miR-371a-3p was assayed. Multivariate logistic regression was used to assess the association between postorchiectomy miRNA and relapse. Results and limitationsThirty-four (23%) patients relapsed. There was no association between postorchiectomy miR-371a-3p (2.43 vs 2.74, p = 0.31) or percent decline from before to after orchiectomy (95.8% vs 93.1%, p = 0.14) and relapse. After adjustment for clinical prognostic factors, there remained no association between postorchiectomy miR-371a-3p and relapse (seminoma: odds ratio [OR] 1.33, 95% confidence interval [CI] 0.87–2.02, p = 0.18; NSGCT: OR 0.45, 95% CI 0.21–1.00, p = 0.05). Postorchiectomy miR-371a-3p levels rose as the date of miRNA assessment approached relapse. At relapse, serum markers alpha-fetoprotein and human chorionic gonadotropin were normal in 62%; yet, miR-371a-3p was elevated in 32/34 (94.1%). The magnitude of miR-371a-3p elevation at relapse correlated with disease burden (N1/M0 122.5 vs N2-N3/M0: 521.1; p = 0.05). Limitations include small numbers of relapses and variable time points of serum collection. ConclusionsIn our cohort of CSI testis cancer patients on surveillance, postorchiectomy miR-371a-3p levels were not associated with relapse, suggesting that miR-371a-3p may not be a useful biomarker for guiding adjuvant therapy. Our data suggest that miR-371a-3p holds potential as an early relapse marker and warrants a prospective study, as this may allow a window for less morbid relapse therapy. Patient summaryThe promising novel blood biomarker for testis cancer miR-371a-3p may not provide information at testicle removal, but serial monitoring may lead to earlier detection of relapse.

Cancer cure for 32 cancer types: results from the EUROCARE-5 study.

Few studies have estimated the probability of being cured for cancer patients. This study aims to estimate population-based indicators of cancer cure in Europe by type, sex, age and period. 7.2 million cancer patients (42 population-based cancer registries in 17 European countries) diagnosed at ages 15-74 years in 1990-2007 with follow-up to 2008 were selected from the EUROCARE-5 dataset. Mixture-cure models were used to estimate: (i) life expectancy of fatal cases (LEF); (ii) cure fraction (CF) as proportion of patients with same death rates as the general population; (iii) time to cure (TTC) as time to reach 5-year conditional relative survival (CRS) >95%. LEF ranged from 10 years for chronic lymphocytic leukaemia patients to <6 months for those with liver, pancreas, brain, gallbladder and lung cancers. It was 7.7 years for patients with prostate cancer at age 65-74 years and >5 years for women with breast cancer. The CF was 94% for testis, 87% for thyroid cancer in women and 70% in men, 86% for skin melanoma in women and 76% in men, 66% for breast, 63% for prostate and <10% for liver, lung and pancreatic cancers. TTC was <5 years for testis and thyroid cancer patients diagnosed below age 55 years, and <10 years for stomach, colorectal, corpus uteri and melanoma patients of all ages. For breast and prostate cancers, a small excess (CRS < 95%) remained for at least 15 years. Estimates from this analysis should help to reduce unneeded medicalization and costs. They represent an opportunity to improve patients' quality of life.

When is a cancer patient cured? (Results from the EUROCARE-5 study)

Abstract Background Although heterogenous risks of recurrence or late effects according to cancer type and host factors exist, increasing evidence of cure has emerged for some cancers. This leads, among other important topics, to the so-called “right to be forgotten” law, adopted in France and Belgium to help cancer survivors access loans and insurance. The aim of the study was to estimate population-based indicators of cancer cure in Europe by type, sex, age, and period. Methods Data from 7.2 million cancer patients, aged 15-74 years, from 42 population-based cancer registries in 17 countries were extracted from the EUROCARE-5 dataset. Mixture-cure models were used to estimate: a) median life expectancy of fatal cases (LEF); b) cure fraction (CF) as a proportion of patients with death rates similar to the general population; and c) time to cure (TTC) as the time to reach five-year conditional relative survival (CRS)&amp;gt;95%. Results LEF ranged from 10 years for patients with chronic lymphocytic leukemia to &amp;lt; 6 months for those with liver, pancreas, brain, gallbladder, and lung cancers. The CF was 94% for testis, 87% for thyroid cancer in women (70% in men), 86% for skin melanoma in women (76% in men), 66% for breast, 63% for prostate, and &amp;lt;10% for liver, lung, and pancreatic cancers. TTC was &amp;lt;5 years for testis and thyroid cancer patients diagnosed below age 55 years, and &amp;lt;10 years for stomach, colorectal, corpus uteri, and melanoma patients of all ages. For breast and prostate cancers, a small excess remained for at least 15 years. Conclusions In a context of increasing number of people living after a cancer diagnosis, these results may help to reduce unneeded medicalization (e.g., follow-up) and resources needed for their care, and they further document that there is already a cure for some cancers. Fundings This work was supported by the Italian Association of Cancer Research (AIRC) and the European Commission (IPAAC). Key messages Cancer cure indicators are provided for European patients and 32 cancer type. Recognizing cancer patients as cured has relevant clinical and social implications.

Effect of Primary Testicular Tumor Localization on Prognosis and Survival of Non-seminomatous Testis Cancer Patients

Effect of Primary Testicular Tumor Localization on Prognosis and Survival of Non-seminomatous Testis Cancer Patients

Priorities in testis cancer care during Covid-19 Pandemic.

ABSTRACTIntroduction:There is little information on how to prioritize testis cancer (TC) patients' care during COVID-19 pandemic in order to relieve its pressure on the health care systems.Objective:To describe the recommendations for diagnosis, treatment and follow-up of patients with TC amidst COVID- 19 pandemic.Material and Methods:Pubmed search and review of the main urological association guidelines on TC.Results:The biology of TC requires immediate care of patients during diagnosis, initial surgical therapy and management of recurrent disease. Active surveillance is the first choice of management and should be offered to all compliant clinical stage I TC patients provided they understand the need to self-isolate. Active surveillance may also help decrease the demand for intensive care unit beds, ventilators, personal protective equipment, and other critical hospital and human resources by minimizing surgeries without compromising patient outcomes. Complications of therapy and symptomatic patients represent medical emergencies and should be treated immediately. Telemedicine may be useful during follow-up periods.Conclusions:Most stages of testis cancer require urgent care; however, all recommendations must be adapted to local health care priorities considering that most of these patients are at low risk of severe COVID-19 infection.

MP11-11 VALIDATION AND IMPLEMENTATION OF A MOBILE APP DECISION SUPPORT SYSTEM FOR QUALITY ASSURANCE OF MULTIDISCIPLINARY TUMOR BOARDS (MTD) TO OPTIMIZE MANAGEMENT OF ADVANCED TESTICULAR CANCER

You have accessJournal of UrologyPenile & Testicular Cancer: Penile & Testicular Cancer I (MP11)1 Apr 2020MP11-11 VALIDATION AND IMPLEMENTATION OF A MOBILE APP DECISION SUPPORT SYSTEM FOR QUALITY ASSURANCE OF MULTIDISCIPLINARY TUMOR BOARDS (MTD) TO OPTIMIZE MANAGEMENT OF ADVANCED TESTICULAR CANCER Yasemin Ural*, Thomas Elter, David Pfister, Michael Hallek, and Axel Heidenreich Yasemin Ural*Yasemin Ural* More articles by this author , Thomas ElterThomas Elter More articles by this author , David PfisterDavid Pfister More articles by this author , Michael HallekMichael Hallek More articles by this author , and Axel HeidenreichAxel Heidenreich More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000831.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: As has been shown recently guideline-compliance is suboptimal concerning the management of testis cancer. Guideline incompliance results in significantly impaired long-term survival. In order to facilitate guideline concordant decisions even in less experienced MTD, we developed a partially algorithm-driven and validated mobile app to provide evidence-based recommendations for first-line therapy. This App contains the latest guideline version and it is continuously updated to include results of practice changing clinical studies. It is the purpose of this study to analyse treatment decision made by MTD compared to guideline recommended therapy. METHODS: 302 testis cancer patients with tumor board decision were randomly selected from our data registry. We analyzed the concordance rates of the MTD recommendations with the query results of the digital App “Easy Oncology”. The query was done by 2 independent persons (urologist, oncologist) who were not aware of the MTD recommendation. MTD decisions were analysed dependent on clinical and IGCCCG stage at time of presentation. Concordance was defined whenever the APP-based recommendation matched MTD recommendation. We defined “non-concordance” when recommendations of APP and MTD did not match. Descriptive statistics and data analysis were done using SPSS Version 25. Correlation analysis of the cancer case characteristics was performed using the Kendalls Tau, Gamma, Pearson and Spearman tests. RESULTS: Median age was 35 years (18-82years, n=245). Clinical stages I, IIA-C, and III were identified in 32%, 37%, and 31%, resp. According to IGCCCG 56%, 18%, and 25% demonstrated good, intermediate, and poor prognosis, resp. 56% were non-seminomas and 44% were seminomas. 60%, 16%, and 7% of MTD decisions were related to 1st-line, 2nd, and 3rd line therapy whereas 18% dealt with follow up. There was no significant correlation between age and clinical stage (p=0,985), age and IGCCCG group (p=0,539), but there was a significant correlation between age and histology (p=0,004). The overall concordance rate was 99% (301/302). Concordance rates in CS I, IIA-C, and III were 100%, 98% and 99%, respectively. Concordance rates with regard to 1rst, 2nd and 3rd line therapy were 99% (135/136), 100%, and 88% (13/14). Identical high concordance rates were achieved by both reviewers. CONCLUSIONS: Based on the data achieved, our validated expert-created mobile decision support system demonstrates easy and reliable application in daily routine in an expert tertiary referral centre. The APP relies on guideline and trial based information and avoids MTD decisions by expert opinions. It might improve the MTD decision in less experienced MTDs which is currently evaluated in a prospective study. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e139-e139 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yasemin Ural* More articles by this author Thomas Elter More articles by this author David Pfister More articles by this author Michael Hallek More articles by this author Axel Heidenreich More articles by this author Expand All Advertisement PDF downloadLoading ...

A Canadian approach to the regionalization of testis cancer: A review.

At the Canadian Testis Cancer Workshop, the rationale and feasibility of regionalization of testis cancer care were discussed. The two-day workshop involved urologists, medical and radiation oncologists, pathologists, radiologists, physician's assistants, residents and fellows, and nurses, as well as patients and patient advocacy groups.This review summarizes the discussion and recommendations of one of the central topics of the workshop - the centralization of testis cancer in Canada. It was acknowledged that non-guideline-concordant care in testis cancer occurs frequently, in the range of 18-30%. The National Health Service in the U.K. stipulates various testis cancer care modalities be delivered through supra-regional network. All cases are reviewed at a multidisciplinary team meeting and aspects of care can be delivered locally through the network. In Germany, no such network exists, but an insurance-supported online second opinion network was developed that currently achieves expert case review in over 30% of cases. There are clear benefits to regionalization in terms of survival, treatment morbidity, and cost. There was agreement at the workshop that a structured pathway for diagnosis and treatment of testis cancer patients is required.Regionalization may be challenging in Canada because of geography; independent administration of healthcare by each province; physicians fearing loss of autonomy and revenue; patient unwillingness to travel long distances from home; and the inability of the larger centers to handle the ensuing increase in volume. We feel the first step is to identify the key performance indicators and quality metrics to track the quality of care received. After identifying these metrics, implementation of a "networks of excellence" model, similar to that seen in sarcoma care in Ontario, could be effective, coupled with increased use of health technology, such as virtual clinics and telemedicine.