Effects of testicular dysgenesis syndrome components on testicular germ cell tumor prognosis and oncological outcomes

Abstract

Purpose: To evaluate whether components of Testicular Dysgenesis Syndrome (TDS) affect testicular germ cell tumor (TGCT) prognosis and oncological outcomes. According to the hypothesis called TDS; undescended testis, hypospadias, testicular cancer and spermatogenic disorders share the same risk factors and have a combined fetal origin. Materials and Methods: We retrospectively evaluated the stages and oncological outcomes of 69 patients who underwent radical orchiectomy between January 2010 and December 2014 due to TGCT in our department. The presence of undescended testis, hypospadias and semen parameters disorders were recorded according to anamnesis of patients. Results: Among 69 patients with TGCT, only 16 (23.1%) had TDS. Significantly higher rate of TDS (36.1% vs. 9.1%) was observed at the advanced stages of TGCT(p=0.008). In the TDS group, the rates of local recurrence (50% vs. 11.3%, p<0.001), distant metastasis (93.6% vs. 3.8%, p<0.001) and cancer-spesific mortality (87.5% vs. 3.8%, p<0.001) were found significantly higher than those without TDS. The predicted time for recurrence-free survival (13.70±5.13 vs. 100.96±2.83 months, p<0.001) metastasis-free survival (13.12±4.21 vs. 102.79±2.21 months, p <0.001) and cancer-specific survival (13.68±5.38 vs. 102.80±2.19 months, p<0.001) were also statistically lower in this group. Conclusions: According to our preliminary results, there is an apparent relationship between TDS and tumor prognosis. Even if the components of TDS alone did not contain poor prognostic features for TGCT, the presence of TDS was found as the most important independent predictive factor for oncological outcomes in both seminomas and nonseminomas as well as all patients with TGCT.

Toward a Mechanistic Understanding of Poly- and Perfluoroalkylated Substances and Cancer

“…For example, a meta-analysis of 10 studies on EDCs and testicular cancer risk concluded that maternal exposure, but not adult exposure, to EDCs was associated with a >2-fold higher risk of testicular cancer in offspring [ 132 ]. This has led to the proposition that testicular cancer is an extreme case of a “testicular dysgenesis syndrome” that includes cryptorchidism, hypospadias, poor semen quality, and male subfertility due to environmental abnormalities, especially those associated with low androgen levels during gonadal development [ 135 , 136 ]. In fact, the above-mentioned conditions, along with congenital disorders of sex development, are known risk factors for TGCTs [ 134 , 137 , 138 ].…”

Prognostic factors in patients with clinical stage I nonseminoma—beyond lymphovascular invasion: a systematic review

“…Cryptorchidism is part of the testicular dysgenesis syndrome (TDS), which also comprises hypospadia and semen parameters disorders. Selvi et al found a strong correlation of TDS with the development of metastasis for TGCTs [ 31 ]. These results on cryptorchidism and TDS have to be interpreted with care, as the results are based on a small patient cohort and the characteristics of cryptorchidism as ipsi- or contralaterality and treatment history were not defined.…”

The role of radiological surveillance in the conservative management of incidental small testicular masses: A systematic review

“…Despite the reported increased risk of testicular cancer in this population, the incidence of benign pathology is as high as 75% in those with incidental testicular lesions detected during infertility evaluation [ 20 ]. Patients presenting with non-obstructive azoospermia or severe semen abnormalities might demonstrate an increased risk of tumorigenesis [ 21 ], which may be associated with an underlying condition such as Klinefelter syndrome, cryptorchidism or testicular dysgenesis syndrome [ 22 ]. If surgical exploration becomes indicated in this cohort, microdissection for sperm extraction in such cases has been reported to be feasible and effective [ 23 ].…”