Malignant germ cell tumours in the elderly: a histopathological review of 50 cases in men aged 60 years or over

Berney, Daniel M.; Warren, Anne Y.; Verma, Monika; Kudahetti, Sak; Robson, Jane; Williams, Michael; Neal, David E.; Powles, Thomas; Shamash, Jonathan; Oliver, R. T. D.

doi:10.1038/modpathol.3800978

Cited by 42 publications

(30 citation statements)

References 30 publications

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“…9 Similarly, a histopathologic study of 50 men with GCT diagnosed at age 60 years found larger primary tumor size and more frequent lymphovascular invasion and rete testis involvement compared with historical controls of all ages. 15 In contrast, a recent retrospective series found 77% of 60 patients diagnosed at 60 years presented with stage I disease, 16 comparable with rates in younger patients. 17,18 Although our study does not allow direct comparison of stage distribution for older versus younger men, stage and initial treatment are provided for 166 GCT patients who presented to MSKCC at 50 years.…”

Section: Discussionmentioning

confidence: 93%

Clinical features, presentation, and tolerance of platinum‐based chemotherapy in germ cell tumor patients 50 years of age and older

Feldman

Voss

Jacobsen

et al. 2013

Cancer

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BACKGROUND: Germ cell tumors (GCTs) primarily affect adolescent and young adult men. Detailed clinical and treatment characteristics in older men are lacking. METHODS: Patients with GCT seen over a 20-year period at Memorial Sloan-Kettering Cancer Center were identified. Primary tumor site and histology were compared for patients aged 50 years at diagnosis versus younger men. For patients aged 50, individual chart review was performed and treatment delays, changes, and toxicities were recorded for those treated with first-line chemotherapy. RESULTS: Of 4235 diagnoses of GCT, 3999 (94.4%) were made at age < 50 versus 236 (5.6%) at age 50. Compared with patients diagnosed before age 50, older men more frequently had seminoma (62.7% versus 36.7%) and less frequently, nonseminoma (34.7% versus 63.2%) (P <.0001). Predominant histology switched from nonseminoma to seminoma around age 35. Distribution of primary sites also differed for older versus younger men (testis: 89.4% versus 92.9%; retroperitoneal: 3.8% versus 0.7%; CNS 0% versus 1.7%) except for mediastinal primary tumors, which remained constant across age groups. Fifty patients age 50 received first-line platinum-based chemotherapy; 30 experienced complications leading to treatment discontinuation, delay 7 days, or regimen change. Twenty-two (44%) patients experienced neutropenic fever, 6 despite prophylactic growth factor support. Estimated 5-year survival for chemotherapy-treated patients was 84.9%. CONCLUSIONS: Men aged 50 years comprise less than 10% of GCT diagnoses and have distinct clinical and histological characteristics as compared with younger patients. Although complications from chemotherapy occur frequently in older men, prognosis remains excellent when risk-directed treatment is administered with curative intent. Cancer 2013;119:2574-81. V C 2013 American Cancer Society.KEYWORDS: germ cell tumors; testicular cancer; age over 50; epidemiology; histology; primary site; cisplatin. INTRODUCTIONGerm cell tumors (GCTs) primarily affect adolescent and young adult men, with diagnoses in older patients, children, and women occurring much less commonly. In men, most GCTs arise in the testis but extragonadal primary tumor sites comprise up to 10% of cases, typically in midline locations such as the mediastinum, retroperitoneum, or pineal gland. The World Health Organization classification of tumors 1 categorizes GCTs in adolescents and adults into 3 histologic groups: classic seminoma with pure histology; nonseminomatous GCT (NSGCT), comprising embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma, and mixed histologies (which can include seminoma); and spermatocytic seminoma.2 In most epidemiological studies, rates of seminoma slightly exceed those of NSGCT, 3,4 with spermatocytic seminoma comprising < 1% of cases. The incidence of seminoma and NSGCT differs across age groups, peaking between ages 35 and 39 years for seminoma compared with 25 to 29 years for NSGCT. 4 Nevertheless, both histologic types are rare in older men with fewer than 10% a...

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Section: Discussionmentioning

confidence: 93%

Clinical features, presentation, and tolerance of platinum‐based chemotherapy in germ cell tumor patients 50 years of age and older

Feldman

Voss

Jacobsen

et al. 2013

Cancer

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“…Information is scarce in the available literature regarding the clinical outcome of older patients with malignant germ cell tumours in the era of platinum‐based chemotherapy, with just a few case reports of successful treatment [9–11]. A recent pathological review [2] of 50 germ cell tumours in the elderly (median age 67 years) found that most were seminomas (82% compared to the 73% reported in the series of the present study); however, complete information about staging or outcome was not given. This report[2] suggested that older patients presented with more locally advanced disease than younger patients; however, this has not been the experience in our series, where 77% of patients presented with stage I disease, which is similar to other contemporary series in a non‐age selected population [12].…”

Section: Discussionmentioning

confidence: 99%

“…Non‐seminoma occurs at a median age of 27 years, and seminoma at a median age of 37 years. Patients also present into older age, typically with comorbidity, and with presentation at a later stage [2]. The incidence of testicular cancer is increasing, with a doubling of new cases diagnosed in Great Britain between 1975 and 2007, to an age standardized rate of 6.6 per 100 000 population.…”

Section: Introductionmentioning

confidence: 99%

The clinical features and management of testicular germ cell tumours in patients aged 60 years and older

Wheater¹,

Manners²,

Nolan³

et al. 2011

BJU International

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Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject ? and What does the study add? The treatment of younger men with testicular germ cell cancers is well documented with established intensive chemotherapy regimens for those with advanced disease. Although the majority of patients present in the third or fourth decade, men also present in later life. These patients are typically excluded from clinical trials and there are no contemporary published series describing their management. This series describes the management of older patients with testicular germ cell tumours at both early and advanced stages of disease. Patients with stage I seminoma can be safely managed with all recognised treatment strategies and state I non‐seminomas were managed with surveillance. Cure can still be achieved in older patients with advance germ cell tumours however chemotherapy regimens developed in younger patients must be tailored to the presence of co‐morbidity. OBJECTIVES • To review the practice of a large referral centre for the management of older patients with testicular germ cell cancer (GCC). • There are few published data available on the management of testicular GCC in elderly patients, who often have medical comorbidities and have been excluded from clinical trials. PATIENTS AND METHODS • We reviewed our prospectively collected database for patients presenting with GCC who were aged ≥60 years. • Details of presentation, management and outcome were recorded. RESULTS • In total, 60 patients aged ≥60 years were identified from 1461 patients treated with GCC from 1979–2005, representing 4% of the total population. • Median age was 67 years, 44 had seminoma (73%) and 16 had non‐seminoma histology (27%). • Stage I seminoma patients were managed with surveillance, adjuvant radiotherapy and adjuvant carboplatin. All stage I non‐seminomas underwent surveillance. • In total, 15 patients received systemic chemotherapy for metastatic disease with modified bleomycin, etoposide and cisplatin; etoposide and cisplatin; carboplatin‐based regimens; or other combinations. Toxicity was manageable, with no toxic deaths. • In total, four patients (6.7%) died of GCC. CONCLUSIONS • In elderly patients, GCC should be managed with curative intent. • Conventional therapies are tolerable for most men with stage I seminoma. In metastatic disease, comorbidity may necessitate treatment modifications. • Most patients are cured with manageable toxicity.

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“…Methodologically data from all federal states in Germany showed a high percentage of data completeness which is important for reliability of our findings. Our demographic analysis confirmed older age for seminoma patients compared to non‐seminoma patients which is consistent with other recent and earlier reports from the 1990s (Stone et al ., ; Agnarsson et al ., ; Berney et al ., ; Ruf et al ., ). The age difference between both entities in our study was 9 years and is reported to range between 6 and 9 years between seminoma and non‐seminoma patients (Agnarsson et al ., ; Ruf et al ., ).…”

Section: Discussionmentioning

confidence: 99%

Trend analysis and regional tumor incidence in Germany for testicular cancer between 2003 and 2014

et al. 2019

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Background: Testicular germ cell tumor (TGCT) is one the most common solid tumors in men between the age of 15 and 35 with an overall incidence rate of 1-1.5 %. Epidemiologic studies have demonstrated different incidence patterns in western civilized countries with overall rising incidence trends. Objective: To analyze differences in regional tumor incidence rates for TGCT and perform a trend analysis for TGCT between 2003 and 2014 in Germany. Material and methods: TGCT cases in Germany which were diagnosed between 2003 and 2014 were provided by the Robert-Koch-Institute, Berlin. For statistical analysis, cluster and spatial scan tests according to Kulldorff were used for cases with seminoma and non-seminoma. Results are presented in administrative districts and graphically illustrated. We performed a trend-analysis in order to evaluate age-adjusted incidence trends in Germany. Tests were two-sided with a level of significance of a=0.05. Results: In total we included 35,066 patients. Overall, 22,634 cases had newly diagnosed seminoma and 12,432 were diagnosed as non-seminoma. Maximum incidence of seminoma and non-seminoma was observed for age-group 38-40 years and 26-28 years, respectively. No second peak for the incidences of seminoma and non-seminoma with respect to age were observed. Cluster analysis revealed areas with high and low incidence rates as well as slightly different spatial distribution in Germany between seminoma and nonseminoma. Furthermore, there was no significant increase in age-adjusted incidence rates over the reviewed time period in both cohorts. Discussion: In this study differences in reginal tumor incidence rates for seminoma and non-seminoma are reported with both tumor entities revealing distinct clusters. Furthermore, tumor incidence trends for seminoma and nonseminoma between 2003 and 2014 were stable which might indicate the beginning of a plateau phase for TGCT incidence rates in Germany. Conclusion: In this analysis we were able to identify regions with significantly higher tumor incidence rates for both seminoma and non-seminoma which were specific for these two subtypes. Furthermore, trend analysis revealed a steady incidence rate for testicular cancer in Germany.

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Malignant germ cell tumours in the elderly: a histopathological review of 50 cases in men aged 60 years or over

Cited by 42 publications

References 30 publications

Clinical features, presentation, and tolerance of platinum‐based chemotherapy in germ cell tumor patients 50 years of age and older

Clinical features, presentation, and tolerance of platinum‐based chemotherapy in germ cell tumor patients 50 years of age and older

The clinical features and management of testicular germ cell tumours in patients aged 60 years and older

Trend analysis and regional tumor incidence in Germany for testicular cancer between 2003 and 2014

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