Active surveillance as a successful management strategy for patients with clinical stage I germ cell testicular cancer

Escudero-Ávila, R; Rodríguez-Castaño, J D; Osmán, Ignacio; Fernández, F. Díaz; Medina, Rafael; Vargas, Blanca; Japón-Rodríguez, M; Sancho, Pilar; Pérez-Valderrama, Begoña; Praena-Fernández, Juan Manuel; Durán, Ignacio

doi:10.1007/s12094-018-1990-5

Cited by 13 publications

(6 citation statements)

References 24 publications

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“… 20 , 21 Moreover, about 20% of seminoma patients will experience relapse, and the reason for this phenomenon is unclear. 22 , 23 Relapsed patients will be treated again using conventional and high-dose chemotherapy with stem cell transplant that aggravate side effects drastically.…”

Section: Introductionmentioning

confidence: 99%

Integrated Molecular Analysis Reveals 2 Distinct Subtypes of Pure Seminoma of the Testis

et al. 2022

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Objective: Testicular germ cell tumors (TGCT) are the most common solid malignancy in adolescent and young men, with a rising incidence over the past 20 years. Overall, TGCTs are second in terms of the average life years lost per person dying of cancer, and clinical therapeutics without adverse long-term side effects are lacking. Platinum-based regimens for TGCTs have heterogeneous outcomes even within the same histotype that frequently leads to under- and over-treatment. Understanding of molecular differences that lead to diverse outcomes of TGCT patients may improve current treatment approaches. Seminoma is the most common subtype of TGCTs, which can either be pure or present in combination with other histotypes. Methods: Here we conducted a computational study of 64 pure seminoma samples from The Cancer Genome Atlas, applied consensus clustering approach to their transcriptomic data and revealed 2 clinically relevant seminoma subtypes: seminoma subtype 1 and 2. Results: Our analysis identified significant differences in pluripotency stage, activity of double stranded DNA breaks repair mechanisms, rates of loss of heterozygosity, and expression of lncRNA responsible for cisplatin resistance between the subtypes. Seminoma subtype 1 is characterized by higher pluripotency state, while subtype 2 showed attributes of reprograming into non-seminomatous TGCT. The seminoma subtypes we identified may provide a molecular underpinning for variable responses to chemotherapy and radiation. Conclusion: Translating our findings into clinical care may help improve risk stratification of seminoma, decrease overtreatment rates, and increase long-term quality of life for TGCT survivors.

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Section: Introductionmentioning

confidence: 99%

Integrated Molecular Analysis Reveals 2 Distinct Subtypes of Pure Seminoma of the Testis

et al. 2022

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“…However, the acceptance of active surveillance as a treatment approach for some cancer types, including prostate and testicular cancer, indicates that attitudes toward less active treatment are gaining acceptance among providers and patients when supported by evidence. 48,49 The final theme pertains to risk assessment and tolerance for uncertainty. Our findings indicate that reducing uncertainty is a factor in how one values LCS attributes.…”

Section: Discussionmentioning

confidence: 99%

When Is a Harm a Harm? Discordance between Patient and Medical Experts’ Evaluation of Lung Cancer Screening Attributes

et al. 2021

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Background A shared decision-making (SDM) process for lung cancer screening (LCS) includes a discussion between clinicians and patients about benefits and potential harms. Expert-driven taxonomies consider mortality reduction a benefit and consider false-positives, incidental findings, overdiagnosis, overtreatment, radiation exposure, and direct and indirect costs of LCS as potential harms. Objective To explore whether patients conceptualize the attributes of LCS differently from expert-driven taxonomies. Design Cross-sectional study with semistructured interviews and a card-sort activity. Participants Twenty-three Veterans receiving primary care at a Veterans Affairs Medical Center, 55 to 73 y of age with 30 or more pack-years of smoking. Sixty-one percent were non-Hispanic African American or Black, 35% were non-Hispanic White, 4% were Hispanic, and 9% were female. Approach Semistructured interviews with thematic coding. Main Measures The proportion of participants categorizing each attribute as a benefit or harm and emergent themes that informed this categorization. Key Results In addition to categorizing reduced lung cancer deaths as a benefit (22/23), most also categorized the following as benefits: routine annual screening (8/9), significant incidental findings (20/23), follow-up in a nodule clinic (20/23), and invasive procedures (16/23). Four attributes were classified by most participants as a harm: false-positive (13/22), overdiagnosis (13/23), overtreatment (6/9), and radiation exposure (20/22). Themes regarding the evaluation of LCS outcomes were 1) the value of knowledge about body and health, 2) anticipated positive and negative emotions, 3) lack of clarity in terminology, 4) underlying beliefs about cancer, and 5) risk assessment and tolerance for uncertainty. Conclusions Anticipating discordance between patient- and expert-driven taxonomies of the benefits and harms of LCS can inform the development and interpretation of value elicitation and SDM discussions.

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“…This prevents an accurate subclassification into Type I and II GCTs, although it is expected that the majority will be type I [47,48] When detecting disease, AFP, beta-HCG and LDH are currently the only clinically suitable serum tumour markers. However, these markers are only elevated in~60% of patients at the time of primary diagnosis [60,61]. Novel biomarkers with improved sensitivity and specificity would be of major clinical benefit.…”

Section: Discussionmentioning

confidence: 99%

Treatment and Survival of Malignant Extracranial Germ Cell Tumours in the Paediatric Population: A Systematic Review and Meta-Analysis

Hulsker

Mansori

Fiocco

et al. 2021

Cancers

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Objective: This systematic review and meta-analysis was performed to explore overall survival (OS) and event free survival (EFS) rates internationally over the past two decades and to define specific subgroups with inferior outcomes which may demand different treatment strategies. Methods: The search focused on malignant extracranial germ cell tumours (GCTs) in the paediatric population. The initial database search identified 12,556 articles; 32 articles were finally included in this review, comprising a total of 5095 patients. Results: The studies were heterogeneous, varying from single institution reports to large prospective trials. Older studies, describing eras where non-platinum-based chemotherapy regimens were used, showed clearly worse outcomes. Survival for stage I–II gonadal disease is excellent. On the other hand, patients with an initial alpha-fetoprotein (AFP) > 10,000 ng/mL or kU/L, age > 11 years and stage IV disease confer a survival disadvantage. For testicular disease in particular, lymphovascular invasion and certain histopathological subtypes, such as embryonal carcinoma (EC) and mixed malignant GCTs, survival is poorer. Survival data for sacrococcygeal and mediastinal GCTs show a heterogeneous distribution across studies in this review, independent of year of publication. Patients > 12 years presenting with a mediastinal GCT pose a subpopulation which fares worse than GCTs in other locations or age groups. This is independent of AFP levels, stage of disease or treatment protocol, and these patients may demand a different treatment strategy. Conclusions: This review describes the heterogeneous nature of GCTs in different anatomical locations, impacting on stage at presentation, treatment modalities used and survival data. Despite this heterogeneity, in line with the current developmental biology-based classification system, subpopulations can be defined which have an inferior EFS and OS and where future research and more individualised treatment would help to improve survival.

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Active surveillance as a successful management strategy for patients with clinical stage I germ cell testicular cancer

Cited by 13 publications

References 24 publications

Integrated Molecular Analysis Reveals 2 Distinct Subtypes of Pure Seminoma of the Testis

Integrated Molecular Analysis Reveals 2 Distinct Subtypes of Pure Seminoma of the Testis

When Is a Harm a Harm? Discordance between Patient and Medical Experts’ Evaluation of Lung Cancer Screening Attributes

Treatment and Survival of Malignant Extracranial Germ Cell Tumours in the Paediatric Population: A Systematic Review and Meta-Analysis

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