Clinical Outcomes of Local and Metastatic Testicular Sex Cord-Stromal Tumors

Abstract

Patients with testicular sex cord-stromal tumors and 1 or no high risk feature can be safely observed without retroperitoneal lymph node dissection but longer followup is needed. Given the lack of effective alternative treatments, early retroperitoneal lymph node dissection may be beneficial in those with 2 or more high risk features, or clinical stage IIa disease.

Clinical Outcome in Testicular Sex Cord Stromal Tumors: Testis Sparing vs Radical Orchiectomy and Management of Advanced Disease

“…Delayed RPLND-that is, performed at the time of recurrence after observation for clinical stage I-had very poor efficacy in Indiana and MSKCC series, where all their 7 patients relapsed and 5 died of disease. 5,8 On the other hand, we had 1 case of ours who could be rescued by a delayed RPLND for a 16-mm large retroperitoneal recurrence.…”

“…Nonetheless, available data are not uniformly consistent, both in the identification of risk factors and in the association with recurrence. 5,8,13,15,17 Very few is known about the role of adjuvant treatment after primary treatment. Two experiences from Indiana University and Memorial Sloan-Kettering Cancer Center (MSKCC) recently contributed with their findings with RPLND.…”

“…2 The vast majority of these tumors have a favorable clinical behavior as they rarely spread to lymph nodes and/or to other visceral sites. [3][4][5][6][7][8][9][10][11][12][13][14] Owing to the most frequent low volume and favorable clinical course, the main issue of TSCST concerns the management of primary tumor. In recent years, different case series reported about the feasibility of testis-sparing surgery (TSS), which does not seem to associate with an increased risk of recurrent or metastatic disease.…”

A contemporary population-based study of testicular sex cord stromal tumours: Presentation, treatment patterns, and predictors of outcome

“…15 Most recently, Silberstein et al used similar high-risk histological features to help stratify patients and identify those who may benefit most from RPLND. 12 The six high-risk features included in their risk-stratification model include tumour size greater than 5 cm, necrosis, moderate or severe nuclear atypia, angiolymphatic invasion, infiltrating margins, and greater than five mitotic features per 10 highpower fields. In their cohort of 48 patients with SCST, the majority was observed, while 11 patients underwent RPNLD for either stage I disease with >2 high-risk features or stage IIa disease.…”

“…[4][5][6][7]11 Some centres have employed highrisk histological features in the orchiectomy specimen to riskstratify patients and identify those who may benefit most from RPLND, although none of these findings have been well validated. 8,[11][12][13][14] In addition, no data have been published to date regarding population-level characteristics of this malignancy. Therefore, the objective of this current study is to describe population-level characteristics of SCSTs, ascertain current practice patterns regarding treatment, and assess predictors of overall survival (OS) and cancer-specific survival (CSS).…”