Bilateral Testicular Germ Cell Tumors in the Era of Multimodal Therapy

Ryan Kopp, Michael Chevinsky, Melanie Bernstein, George Bosl, Robert Motzer, Dean Bajorin, Darren Feldman, Brett S. Carver, Joel Sheinfeld

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalUrology
DOIs
StateAccepted/In press - Jul 13 2016
Externally publishedYes

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Therapeutics
Seminoma
Neoplasms
Testicular Germ Cell Tumor
Recurrence
Histology
Incidence
Kaplan-Meier Estimate
Referral and Consultation
Survival Rate
Confidence Intervals
Survival
Population

ASJC Scopus subject areas

  • Urology

Cite this

Kopp, R., Chevinsky, M., Bernstein, M., Bosl, G., Motzer, R., Bajorin, D., ... Sheinfeld, J. (Accepted/In press). Bilateral Testicular Germ Cell Tumors in the Era of Multimodal Therapy. Urology. https://doi.org/10.1016/j.urology.2016.10.018

Bilateral Testicular Germ Cell Tumors in the Era of Multimodal Therapy. / Kopp, Ryan; Chevinsky, Michael; Bernstein, Melanie; Bosl, George; Motzer, Robert; Bajorin, Dean; Feldman, Darren; Carver, Brett S.; Sheinfeld, Joel.

In: Urology, 13.07.2016.

Research output: Contribution to journalArticle

Kopp, R, Chevinsky, M, Bernstein, M, Bosl, G, Motzer, R, Bajorin, D, Feldman, D, Carver, BS & Sheinfeld, J 2016, 'Bilateral Testicular Germ Cell Tumors in the Era of Multimodal Therapy', Urology. https://doi.org/10.1016/j.urology.2016.10.018
Kopp, Ryan ; Chevinsky, Michael ; Bernstein, Melanie ; Bosl, George ; Motzer, Robert ; Bajorin, Dean ; Feldman, Darren ; Carver, Brett S. ; Sheinfeld, Joel. / Bilateral Testicular Germ Cell Tumors in the Era of Multimodal Therapy. In: Urology. 2016.
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abstract = "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.",
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AU - Kopp, Ryan

AU - Chevinsky, Michael

AU - Bernstein, Melanie

AU - Bosl, George

AU - Motzer, Robert

AU - Bajorin, Dean

AU - Feldman, Darren

AU - Carver, Brett S.

AU - Sheinfeld, Joel

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N2 - 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.

AB - 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.

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