Elsevier

Urology

Volume 103, May 2017, Pages 154-160
Urology

Oncology
Bilateral Testicular Germ Cell Tumors in the Era of Multimodal Therapy

https://doi.org/10.1016/j.urology.2016.10.018Get rights and content

Objective

To characterize the incidence, presentation, management, and relapse of a large population of bilateral testicular germ cell tumors (TGCT) from a single institution.

Patients and Methods

We identified bilateral TGCT diagnosed between January 1989 and February 2014. We categorized synchronous and metachronous TGCT, noting time between first and second TGCT, histology (seminoma vs nonseminoma [NSGCT]), stage, and treatments. Kaplan-Meier survival estimates characterized relapse.

Results

Of 5132 patients with TGCT, 128 (2.5%) had bilateral TGCT. Bilateral TGCT increased over time—1.7% in 1989-1994 up to 3.8% in 2010 to February 2014. The 35 (27%) synchronous cases of TGCT had 20 (57%) concordant seminoma, 5 (14%) concordant NSGCT, and 10 (29%) discordant NSGCT. The 93 (73%) metachronous cases had median time interval to second TGCT of 73 months (range: 5 months-28.6 years). Compared with first TGCT, 39 (42%) had discordant histology, 29 (31%) had concordant seminoma, and 25 (27%) had concordant NSGCT. Stage at first tumor was statistically similar to second TGCT (second stage I, II, II in 69%, 22%, 10%). Increasing duration between first and second TGCT was not associated with higher stage (II or III) at second TGCT (P = .09). Treatment at first tumor was not associated with stage at second tumor. Relapse following bilateral diagnosis was 16.8% (95% confidence interval 10.5%-26.2%) at 5 years.

Conclusion

Incidence of bilateral TGCT increased with >25% of metachronous TGCT presenting ≥10 years after first TGCT; possible causes include increased survivorship and referral bias. Stage was statistically similar at first and second tumor; stage at second tumor was not associated with time interval between tumors or prior treatment modality at first tumor.

Section snippets

Study Population

This institutional review board-approved cohort study identified men within the Memorial Sloan Kettering Cancer Center (MSKCC) prospectively maintained TGCT database that were diagnosed with bilateral TGCT. This included men with synchronous tumors or a metachronous second TGCT occurring during the interval from January 1989 to February 2014. Physicians verified data on the diagnosis of each TGCT, treatment, and outcomes. To determine the incidence of bilateral disease, we queried the total

Results

Bilateral TGCT occurred in 128 (2.5%) of the 5132 patients who were diagnosed with a TGCT between January 1989 and February 2014. During this time period, the incidence of bilateral testis cases at MSKCC steadily increased; from 1989 to 1994 only 13 of 747 (1.7%) had bilateral disease, whereas in 2010 to February 2014, bilateral disease represented 39 of 1035 (3.8%) patients with TGCT. Incidence of bilateral disease is illustrated in Table 1. Patients with unilateral TGCT had substantially

Comment

This is the largest single-institution experience with bilateral TGCT to date, and we demonstrate an increasing incidence at a major referral center. Although we cannot determine the impact of referral bias, these data support that the proportion of metachronous TGCT is increasing relative to synchronous TGCT. Perhaps most importantly, greater than 50% of metachronous TGCT cases presented at least 5 years after first tumor and 25% presented 12 years or more after first tumor, ranging up to 28

Conclusion

Incidence of bilateral TGCT at MSKCC increased with >25% of metachronous TGCT presenting ≥10 years after first TGCT; causes could be increased survivorship or referral bias. Stage was statistically similar at first and second tumor; stage at second tumor was not associated with time interval between tumors or prior treatment modality of first tumor. Regional or systemic treatments at first tumor do not preclude the need for further regional or systemic treatments at second TGCT. These findings

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Following completion of this manuscript, author affiliations have changed for the following:

Ryan P. Kopp's affiliation has changed to Oregon Health & Science University and VA Portland Healthcare System, Portland, OR.

Michael Chevinsky's affiliation has changed to Washington University, St. Louis, MO.

Financial Disclosure: The authors declare that they have no relevant financial interests.

Funding Support: This study was supported by the Capri Foundation and Sidney Kimmel Center for Prostate and Urologic Cancers.

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