Prognostıc Factors In Testıcular Cancer

Öz

Aim: Testicular cancer is the most common cancer in men aged 15-35 years and accounts for 1% of all lifetime male cancers. There are two histologic subtypes: seminoma and nonseminoma. In our study, we aimed to investigate the factors predicting recurrence in early-stage testicular cancer. Materials and Methods: Our study is a retrospective study of early stage testicular cancer admitted to the medical oncololi clinic of our hospital between 2006-2018. During the study, 344 patient files were reviewed and 130 patients who met the study criteria were included in the study. Our primary aim in this study was to investigate the factors predictive of recurrence in early stage testicular cancer. Results: When evaluating PFS in patients with nonseminoma with and without lymphovascular invasion, no median PFS value was reached in either group. However, PFS was worse in patients with LVI (p=0.037). When comparing stage 1 with stage 2 seminoma patients, no median PFS values could be reached, but there was a statistical difference between the two groups in terms of recurrence (p=0.019). Conclusions: In our study, we found no association between tumor size, embryonal carcinoma predominance, tunica albuginea invasion, spermatic cord involvement and tumor marker values and recurrence in nonseminoma germ cell testicular tumors. PFS was shorter in patients with LVI compared to those without LVI. Lymphovascular invasion, spermatic cord involvement, tunica albuginea involvement, and rete testis involvement were not associated with disease recurrence in seminoma patients, whereas higher disease stage predicted the risk of recurrence.

Anahtar Kelimeler

• Prognosis
• Cancer
• Testicular Germ Cell Tumor

Testis Kanserinde Prognostik Faktörler

Öz

Amaç: testis kanserleri 15-35 yaş arası erkeklerde en sık görülen kanser olup tüm yaşam boyu erkek kanserlerinin %1’ini oluşturmaktadır. Seminom ve nonseminom olarak iki histolojik subtipi vardır. Çalışmamızda erken evre testis kanserlerinde nüksü predikte eden faktörleri araştırmayı amaçladık Gereç ve Yöntemler: Çalışmamız, 2006-2018 yılları arasında hastanemiz Tıbbi onkololi kliniğine başvuran erken evre testis kanserlerinin incelendiği retrospektif bir çalışmadır. Çalışma sırasında 344 hasta dosyası taranmış olup çalışma kriterlerine uyan 130 hasta çalışmaya dahil edildi. Bu çalışmada primer amacımız erken evre testis kanserlerinde nüksü predikte eden faktörleri araştırmaktı. Bulgular: Nonseminoma hastalarında Lenfovasküler invazyonu olan ve olmayan hastaların PFS açısından yapılan değerlendirmede, her iki grupta da median PFS değerine ulaşılamadı. Ancak LVİ olan hastalarda PFS daha kötü olarak saptandı (p=0.037). Seminom hastalarında evre 1 ile evre 2’nin karşılaştırılmasında median PFS değerlerine ulaşılamadı, ancak iki grup arasında rekürrens açısından istatiksel farklılık vardı (p=0.019) Sonuçlar: Çalışmamızda nonseminom germ hücreli testis tümörlerinde tümör boyutu, embriyonel karsinom predominans, tunika albuginea invazyonu, spermatik kord tutulumu ve tümör markır değerleri ile nüks arasında bir ilişki saptamadık. LVİ olan ve olmayanlar kıyaslandığında, LVİ olan hastalarda PFS daha kısa idi. Seminom hastalarında lenfovasküler invazyon, spermatik kord tutulumu, tunika albuginea tutulumu ve rete testis tutulumu ile hastalık rekürensi arasında ilişki izlenmezken, hastalığın evresinin yüksek olması rekürrens riskini predikte etmekte idi.

Anahtar Kelimeler

• prognoz
• kanser
• testis germhücreli kanser

Destekleyen Kurum

Yok

Etik Beyan

bu çalışmanın etik onamı 16.07.2020 tarihinde 270 numara ile Dicle Üniversitesi girişimsel olmayan klinik araştırmalar etik kurulundan alınmıştır

Kaynakça

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin 2019; 69:7.
2. Groll RJ, Warde P, Jewett MA. A comprehensive systematic review of testicular germ cell tumor surveillance. Crit Rev Oncol Hematol 2007; 64:182.
3. Warde P, Gospodarowicz M. Evolving concepts in stage I seminoma. BJU Int 2009; 104:1357.
4. Vasdev N, Moon A, Thorpe AC. Classification, epidemiology and therapies for testicular germ cell tumours. Int J Dev Biol 2013;57:133–139.
5. Van de Wetering RAW, Sleijfer S, Feldman DR, Funt SA, Bosl GJ, de Wit R. Controversies in the management of clinical stage I seminoma: carboplatin a decade in-time to start backing out. J Clin Oncol. 2018; 36(9): 837-840.
6. Sturgeon JF, Moore MJ, Kakiashvili DM, Duran I, Anson LC, Berthold DR, et al. Non-risk-adapted surveillance in clinical stage I nonseminomatous germ cell tumors: the Princess Margaret Hospital's experience. Eur Urol 2011; 59:556.
7. Stenning S, Oliver T, Mead B, Gabe R. Carboplatin in clinical stage I seminoma: a valuable option for patient management. J Clin Oncol 2011; 29:4210.
8. Oliver RT, Mead GM, Rustin GJ, Joffe JK, Aass N, Coleman R, et al. Randomized trial of carboplatin versus radiotherapy for stage I seminoma: mature results on relapse and contralateral testis cancer rates in MRC TE19/EORTC 30982 study (ISRCTN27163214). J Clin Oncol 2011; 29:957.

9. Stephenson AJ, Sheinfeld J. Management of patients with low-stage nonseminomatous germ cell testicular cancer. Curr Treat Options Oncol 2005; 6:367.
10. Pectasides D, Pectasides E, Constantinidou A, Aravantinos G. Current management of stage I testicular non-seminomatous germ cell tumours. Crit Rev Oncol Hematol 2009; 70:114.
11. P. Albers (Chair), W. Albrecht, F. Algaba, C. Bokemeyer, G. CohnCedermark, K. Fizazi, et al. Guidelines Associates: J.L. Boormans,, J. Mayor de Castro EAU Guidelines 2018 http://uroweb.org/ guideline/testicular-cancer/
12. Lashley DB, Lowe BA. A rational approach to managing stage I nonseminomatous germ cell cancer. Urol Clin North Am 1998;25:405–23.
13. Spiess PE, Tannir NM, Brown GA, Liu P, Tu SM, Evans JG, et al. Recurrence in nonseminomatous germ cell testis tumor patients with no viable tumor at postchemotherapy retroperitoneal lymph node dissection. Urology. 2007 Dec;70(6):1173-8.
14. Donohue JP, Thornhill JA, Foster RS, Rowland RG, Bihrle R. Primary retroperitoneal lymph node dissection in clinical stage A nonseminomatous germ cell testis cancer. Review of the Indiana University experience 1965–1989. Br J Urol 1993;71:326
15. Krege S, Souchon R, Schmoll HJ; German Testicular Cancer Study Group. Interdisciplinary consensus on diagnosis and treatment of testicular germ cell tumours: result of an update conference on evidence-based medicine (EBM). Eur Urol 2001;40(4):372-391
16. Tandstad T, Stahl O, Dahl O, Haugnes HS, Hakansson U, Karlsdottir A, et al. Treatment of stage I seminoma, with one course of adjuvant carboplatin or surveillance, risk-adapted recommendations implementing patient autonomy: a report from the Swedish and Norwegian Testicular Cancer Group (SWENOTECA). Ann Oncol 2016;27:1299-1304.
17. Warde P, Specht L, Horwich A, Oliver T, Panzarella T, Gospodarowicz M, et al. Prognostic factors for relapse in stage I seminoma managed by surveillance: a pooled analysis. J Clin Oncol 2002;20:4448-4452.
18. Aparicio J, Maroto P, Garcia del Muro X, Munoz AS, Guma J, Margeli M, et al. Prognostic factors for relapse in stage I seminoma: a new nomogram derived from three consecutive, risk-adapted studies from the Spanish Germ Cell Cancer Group (SGCCG). Ann Oncol 2014;25:2173-2178.
19. International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers. International Germ Cell Cancer Collaborative Group. J Clin Oncol 1997; 15:594
20. Feldman DR, Bosl GJ, Sheinfeld J, Motzer RJ. Medical treatment of advanced testicular cancer. JAMA 2008; 299:672.
21. Birch R, Williams S, Cone A, Einhorn L, Roark P, Turner S, et al. Prognostic factors for favorable outcome in disseminated germ cell tumors. J Clin Oncol 1986; 4:400.
22. Amin MB, Edge SB, Greene F, Compton CC, Gershenwald JE, Brookland RK, et al., eds. AJCC Cancer Staging Manual, 8th ed. New York: Springer International Publishing; 2017.