Risk Assessment for Metastatic Testis Cancer

McCaffrey, John; Bajorin, Dean F.; Motzer, Robert J.

doi:10.1016/s0094-0143(05)70029-x

Cited by 10 publications

(9 citation statements)

References 16 publications

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“…Eleven patients (61.11%) died during the follow up period, but seven patients (38.89%) were alive after five years. These cure rates are much lower than those reported elsewhere (2,13,41), and is due to the fact that no cisplastin based chemotherapy combination was used in this group probably due to its high cost. It is hoped that these results will encourage surgeons in this locality to insist on cisplastin based combination chemotherapy for testicular cancer irrespective of costs.…”

Section: Discussioncontrasting

confidence: 74%

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Testicular cancer at Kenyatta National Hospital, Nairobi

Opot

Magoha²

2009

E Af Med Jrnl

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Objective: To determine the prevalence, clinical characteristics, management methods and prognosis of testicular cancer at Kenyatta National Hospital. Design: Retrospective case study of testicular cancer patients over a fifteen year period. Setting: Kenyatta National Hospital, a referral and teaching hospital. Participants: All histologically confirmed testicular cancer patients recorded at the Histopathology Department of Kenyatta National Hospital between 1983 and 1997. Results: The mean age was 34.8 years with a peak incidence in the 30-44 year age group. History of cryptochirdism was obtained in 10.26% of the patients. Thirty one patients (79.49%) presented with painless testicular swellings, eleven (28.08%) with pain, nine (23.08%) with scrotal heaviness, six (15.38%) with abdominal swellings and one (2.56%) each with gynaecomastia and eye swelling. On examination 32 patients (82.05%) had testicular masses, ten (25.64%) had abdominal masses, seven (17.91%) had supraclavicular and cervical lymphadenopathy, and one each (2.56%) had gynaecomastia and eye mass respectively. More than eighty nine per cent had germ cell cancers with seminoma accounting for 67.35%, teratoma 12.24%, embroyonal carcinoma 8.16%, rhabdomyosarcoma 6.12% and malignant germ cell tumour, orchioblastoma and dysgerminoma each accounted for 2.04%. Three patients (7.7%) had orchidectomy and radiotherapy and chemotherapy, sixteen (41.03%) had orchidectomy and radiotherapy, six (15.38%) had orchidectomy and chemotherapy, ten (25.64%) had radiotherapy and chemotherapy, three (7.7%) and two (5.13%) had only chemotherapy and radiotherapy respectively. No cisplastin based chemotherapy regime was used. Follow up was effected for eighteen patients (46.15%) and seven patients (38.89%) were alive after five years. Conclusion: Prognosis with current regimes was poor with survival of only 38.89% after five years. Cisplastin based chemotherapy with up to 90% cure rates should be included as a component of testicular cancer management at Kenyatta National Hospital.

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Section: Discussioncontrasting

confidence: 74%

“…This combined multimodal approach using improved surgical techniques, radiotherapy and cisplastin based chemotherapy has resulted in cure rates of 80 -90% in germ cell cancers (41). There is however controversy about the management of residual retroperitoneal mass after chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Testicular cancer at Kenyatta National Hospital, Nairobi

Opot

Magoha²

2009

E Af Med Jrnl

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“…All variables were categorical, since no major differences in performance were found compared to using continuous variables (McCaffrey et al, 1998). In Table 1, how the risk factors were combined into three prognostic groups for patients with nonseminomatous germ cell tumours (NSGCT) Furthermore, it is difficult to adjust the current classification for changes in treatment strategy.…”

mentioning

confidence: 99%

Survival of patients with nonseminomatous germ cell cancer: a review of the IGCC classification by Cox regression and recursive partitioning

et al. 2004

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The International Germ Cell Consensus (IGCC) classification identifies good, intermediate and poor prognosis groups among patients with metastatic nonseminomatous germ cell tumours (NSGCT). It uses the risk factors primary site, presence of nonpulmonary visceral metastases and tumour markers alpha-fetoprotein (AFP), human chorionic gonadotrophin (HCG) and lactic dehydrogenase (LDH). The IGCC classification is easy to use and remember, but lacks flexibility. We aimed to examine the extent of any loss in discrimination within the IGCC classification in comparison with alternative modelling by formal weighing of the risk factors. We analysed survival of 3048 NSGCT patients with Cox regression and recursive partitioning for alternative classifications. Good, intermediate and poor prognosis groups were based on predicted 5-year survival. Classifications were further refined by subgrouping within the poor prognosis group. Performance was measured primarily by a bootstrap corrected c-statistic to indicate discriminative ability for future patients. The weights of the risk factors in the alternative classifications differed slightly from the implicit weights in the IGCC classification. Discriminative ability, however, did not increase clearly (IGCC classification, c ¼ 0.732; Cox classification, c ¼ 0.730; Recursive partitioning classification, c ¼ 0.709). Three subgroups could be identified within the poor prognosis groups, resulting in classifications with five prognostic groups and slightly better discriminative ability (c ¼ 0.740). In conclusion, the IGCC classification in three prognostic groups is largely supported by Cox regression and recursive partitioning. Cox regression was the most promising tool to define a more refined classification.

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“…normal [1][2][3]. The principle of treatment for advanced testicular tumor Minowada/Okano/Miyazaki/Homma/ Kitamura is the induction of systemic chemotherapy until the serum tumor markers are normalized.…”

Section: Discussionmentioning

confidence: 99%

“…However, 10-20% of advanced nonseminomatous germ cell tumors (NSGCT) are classified as the poor-risk group [1][2][3]. The survival is especially poor in patients with bulky nonpulmonary visceral metastases and/or extremely elevated serum tumor markers [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary Treatment of Advanced Testicular Tumor with Bulky Liver Metastasis

et al. 2001

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A 21-year-old man with far-advanced nonseminomatous germ cell tumor of the left testis is presented. He had multiple bulky metastases in the liver and retroperitoneum with an extraordinarily elevated serum α-fetoprotein (23,500 ng/ml). He received multidisciplinary treatment consisting of systemic chemotherapy, cytoreductive left hepatic lobectomy, percutaneous ablation therapy, transarterial chemoembolization, and external beam irradiation for median segments of the liver. The efficient combination treatment normalized the tumor markers within 6 months and has maintained complete serological remission for 4.7 years.

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Risk Assessment for Metastatic Testis Cancer

Cited by 10 publications

References 16 publications

Testicular cancer at Kenyatta National Hospital, Nairobi

Testicular cancer at Kenyatta National Hospital, Nairobi

Survival of patients with nonseminomatous germ cell cancer: a review of the IGCC classification by Cox regression and recursive partitioning

Multidisciplinary Treatment of Advanced Testicular Tumor with Bulky Liver Metastasis

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