Comparative Effectiveness of Surveillance, Primary Chemotherapy, Radiotherapy and Retroperitoneal Lymph Node Dissection for the Management of Early Stage Testicular Germ Cell Tumors: A Systematic Review

Pierorazio, Phillip M.; Cheaib, Joseph G.; Patel, Hiten D.; Gupta, Mohit; Sharma, Ritu; Zhang, Allen; Tema, Giorgia; Bass, Eric B

doi:10.1097/ju.0000000000001364

Cited by 19 publications

(18 citation statements)

References 41 publications

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“…Although men with early‐stage TGCTs usually experience excellent cancer‐specific survival, ranging between 94% and 100%, the prognosis and the risk of relapse in our patient remain uncertain due to the rarity of the histopathological finding and the short follow‐up (Pierorazio et al., 2021).…”

Section: Discussionmentioning

confidence: 90%

Testicular seminoma with pagetoid spread into the vas deferens: A rare histopathological presentation

et al. 2021

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Testicular cancer, in particular testicular germ cell tumours, is the most common malignancy in young adult men. Defining prognosis and the best therapeutic strategy is challenging since accurate staging could be controversial. We report an unusual case of seminoma with pagetoid spread into the rete testis and, unexpectedly, also within the epithelium of the vas deferens, up to the margin of excision of the spermatic cord. Focussing on the extremely rare pathological finding and the challenge in defining the stage and the best post‐surgical management, we would like to raise some issues about the knowledge gap on this topic.

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Section: Discussionmentioning

confidence: 90%

Testicular seminoma with pagetoid spread into the vas deferens: A rare histopathological presentation

et al. 2021

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“…All large vessels need to be skeletal. RPLND is prone to erectile dysfunction, lymphatic leakage (lymphedema, chylous ascites), surgical injury (most commonly vascular injury and ureteral injury), surgical infection (lung, incision), intestinal obstruction and other complications ( 24 , 25 ). Besides, infertility was the major long-term toxicity associated with RPLND ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

Develop and validate nomogram to predict cancer-specific survival for patients with testicular yolk sac tumors

Wang²,

Li³

et al. 2022

Front. Public Health

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PurposeTesticular yolk sac tumor (TYST) is a rare malignant germ cell tumor that mainly occurs in young men. Due to the low incidence of yolk sac tumors, there is a lack of prospective cohort studies with large samples. We aimed to develop a nomogram to predict cancer-specific survival (CSS) in patients with TYST.Materials and methodsPatient information was downloaded from the Surveillance, Epidemiology and End Results (SEER) database. We enrolled all patients with TYST from 2000 to 2018, and all patients were randomly divided into a training set and a validation set. Univariate and multivariate Cox proportional hazards regression models were used to identify independent risk factors for patients. We constructed a nomogram based on the multivariate Cox regression model to predict 1-, 3-, and 5-year CSS in patients with TYST. We used a series of validation methods to test the accuracy and reliability of the model, including the concordance index (C-index), calibration curve and the area under the receiver operating characteristic curve (AUC).Results619 patients with TYST were enrolled in the study. Univariate and multivariate Cox regression analysis showed that age, T stage, M stage and chemotherapy were independent risk factors for CSS. A nomogram was constructed to predict the patient's CSS. The C-index of the training set and the validation set were 0.901 (95%CI: 0.859–0.847) and 0.855 (95%CI: 0.865–0.845), respectively, indicating that the model had excellent discrimination. The AUC showed the same results. The calibration curve also indicated that the model had good accuracy.ConclusionsIn this study, we constructed the nomogram for the first time to predict the CSS of patients with TYST, which has good accuracy and reliability and can help doctors and patients make clinical decisions.

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“…This practice was driven by the data which showed excellent outcomes can be achieved with less intensive therapy while simultaneously reducing treatment-related toxicity. 9 Active surveillance is also shown to be the most cost-effective modality of treatment. 10 Our previous study using the same database has shown that active surveillance is now the most common treatment strategy for patients with stage I testicular cancer in Ontario.…”

Section: Discussionmentioning

confidence: 99%

Utilization of imaging for active surveillance in testicular cancer: Is real-world practice concordant with guidelines?

Gyawali

Griffiths²,

Robinson³

et al. 2021

CUAJ

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Introduction: Imaging is an integral component of active surveillance following orchiectomy for stage 1 non-seminoma (NSGCT) and seminoma germ cell tumors. In this population-based study, we describe use of imaging among patients with early-stage testicular cancer and evaluate whether they are concordant with guideline recommendations. Methods: This is a population-based, retrospective cohort study to describe utilization of imaging among all patients with early-stage testicular cancer treated with active surveillance in the Canadian province of Ontario. The Ontario Cancer Registry was linked to electronic records of treatment to identify use of chest and abdomen/pelvis imaging. Data from 2000–-2010 were included with followup for up to five years for patients with non-seminoma and 10 years for patients with seminoma. The key outcome of interest was the frequency of imaging at temporal milestones following orchiectomy. Compared to the most contemporaneous guidelines in Ontario, any discordant frequency of imaging was defined as underutilization or overutilization. Substantial under- or overutilization was defined as >1 imaging test less/more than what was recommended during a 12-month period. Results: The study population included 569 patients with NSGCT (median age 28) and 1107 with seminoma (median age 37). Among patients with NSGCT, adherence with body imaging was low in years 1–3 of surveillance (range 26–37%, predominantly underuse) and higher in years 4–5 (63–67%, predominantly overuse). Adherence with chest imaging was even lower (range 11–34% during years 1–5). Among patients with seminoma, adherence with abdominal and chest imaging was relatively stable and comparable throughout the 10-year followup period (range 23–47% abdomen and 28–47% chest). Multivariable analysis confirmed that underutilization of imaging was more common in recent years. NSGCT histology was associated with underutilization in years 1–2 but overutilization in years 3–5. Conclusions: In routine clinical practice, patients with testicular cancer commonly receive imaging discordant to the protocol for active surveillance, with a substantial proportion receiving both under- and overutilization at various times during surveillance followup.

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Comparative Effectiveness of Surveillance, Primary Chemotherapy, Radiotherapy and Retroperitoneal Lymph Node Dissection for the Management of Early Stage Testicular Germ Cell Tumors: A Systematic Review

Cited by 19 publications

References 41 publications

Testicular seminoma with pagetoid spread into the vas deferens: A rare histopathological presentation

Testicular seminoma with pagetoid spread into the vas deferens: A rare histopathological presentation

Develop and validate nomogram to predict cancer-specific survival for patients with testicular yolk sac tumors

Utilization of imaging for active surveillance in testicular cancer: Is real-world practice concordant with guidelines?

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