Clinical characteristics of testicular germ cell tumors in patients aged 50 years and older: A large-scale study from the Cancer Registration Committee of the Japanese Urological Association.

To determine the characteristics of testicular germ cell tumors in older patients. A testicular cancer survey was carried out by the Japanese Urological Association in 2011 to register the testicular cancers diagnosed in 2005 and 2008. The survey included age, presenting symptoms, physical examination findings, tumor markers, histopathology, clinical stage, treatment and clinical outcomes. These factors were compared between patients aged ≥50 years and those aged <50 years at diagnosis. Of the 1119 cases of primary testicular germ cell tumors, 123 (11.0%) were diagnosed at age ≥50 years. Compared with patients aged <50 years, germ cell tumors in older patients were more frequently seminomas (74.8% vs 61.4%, P = 0.004) and clinical stage I at diagnosis (79.5% vs 70.7%, P = 0.041). Metastatic germ cell tumors in patients aged ≥50 years were more frequently classified into the good prognosis group according to the International Germ Cell Consensus Classification compared with those in younger patients (84.0% vs 53.8%, P = 0.003). Nevertheless, cancer-specific survival of patients aged ≥50 years was not superior to that of younger patients (4-year survival rates; 93.7% vs 97.8%). Testicular germ cell tumors in patients aged ≥50 years are more commonly seminomas, and tend to be diagnosed at earlier stages compared with younger patients; however, the prognosis of older patients is not favorable compared with that of younger patients.

Kawai T ，Tanaka Y ，Cancer Registration Committee of the Japanese Urological Association 《-》

Clinical characteristics and oncological outcomes of testicular cancer patients registered in 2005 and 2008: the first large-scale study from the Cancer Registration Committee of the Japanese Urological Association.

To describe the clinical and pathological characteristics and oncological outcomes of testicular cancer diagnosed in Japan, we report the results of the testicular cancer registration carried out by the Japanese Urological Association. Testicular cancer survey was conducted by the Japanese Urological Association in 2011 to register newly diagnosed testicular cancers in 2005 and 2008. The survey included details such as age, presenting symptoms, physical examination findings, tumor markers, histopathology, clinical stage, initial treatment and clinical outcomes. We analyzed 1121 cases of testicular primary germ cell tumor among 1157 registered patients. The median age was 37.0 years. Seminomas and non-seminomatous germ cell tumors accounted for 61.9% and 38.1%, respectively. Measurements of tumor markers were documented in 98.6% of the patients; however, there was an unsatisfactory uniform measurement of human chorionic gonadotropin, which made it difficult to evaluate the International Germ Cell Consensus Classification in all patients. The 1- and 3-year overall survival rates from the entire cohort were 98.3% and 96.8%, respectively. According to the International Germ Cell Consensus Classification, 3-year overall survival rates in the good, intermediate, and poor prognosis group were 99.1%, 100% and 79.9%, respectively. The present report is the first large-scale study of the characteristics and survival of testicular cancer patients in Japan based on multi-institutional registry data, and showed a good prognosis even in an advanced stage. The improved survival attributed substantially to accurate diagnosis and effective multimodal treatment.

Miki T ，Kamoi K ，Fujimoto H ，Kanayama HO ，Ohyama C ，Suzuki K ，Nishiyama H ，Eto M ，Naito S ，Fukumori T ，Kubota Y ，Takahashi S ，Mikami K ，Homma Y ... -  《-》

Late relapses (>2 years) in patients with stage I testicular germ cell tumors: predictive factors and survival.

Late relapses (>2 years) after completion of chemotherapy are rare and often platinum-resistant. There are limited data concerning late relapses in chemotherapy-naïve patients with stage I germ cell tumors. This retrospective analysis was performed to compare the outcome between patients with stage I germ cell tumors, who had late (≥2 years) and early (≥3 months and <2 years) relapse after orchiectomy. We analyzed data of 1,069 chemotherapy-naïve patients with advanced germ cell tumors of testis treated in our department from 1986 to 2008. All patients had cisplatin- and etoposide-based chemotherapy. We identified 169 (15.8%) patients with prior stage I disease, who had not received adjuvant treatment: 140 and 29 patients had early and late relapse, respectively. Among patients with late relapse, pure seminoma was revealed in 14 patients, and nonseminoma in 15 patients. Median follow-up time for 169 patients was 35 (range, 2-218) months. Patients with late relapse were older, 35 years (23-57) and had more frequent pure seminoma in primary tumor, 14/29 (48.3%), than patients with early relapse, 30 years (16-63) (P = 0.0008) and 46/140 (32,8%, P = 0.08), respectively. At the time of disease progression, both groups were very similar according to well-known prognostic factors including IGCCCG classification. The only difference was larger size of retroperitoneal lymph nodes in late (9 cm) than in early relapse (4 cm, P < 0.0001). The outcome in patients with late relapse was significantly worse than in patients with early relapse: complete response rate after induction chemotherapy was 20.7% (6/29) vs. 42.1% (59/140) (P = 0.01), 3-year progression-free survival 66% vs. 84% (P = 0.02, HR = 2.4, 95% CI 1.2-8.8) and 3-year overall survival, 72% vs. 88% (P = 0.04, HR = 2.4, 95% CI 1.05-10.25), respectively. In patients with pure seminoma, this difference in overall survival was even more significant: 65% vs. 91% (P = 0.04, HR = 3.8, 95% CI 1.06-32.4). Late relapses following stage I germ cell tumors were associated with seminoma, older age, and worse outcome after induction chemotherapy.

Fedyanin M ，Tryakin A ，Kanagavel D ，Bulanov A ，Burova A ，Figurin K ，Fainshtein I ，Sergeev U ，Zakharova T ，Garin A ，Tjulandin S ... -  《-》

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

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. • 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. • We reviewed our prospectively collected database for patients presenting with GCC who were aged ≥60 years. • Details of presentation, management and outcome were recorded. • 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. • 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.

Wheater MJ ，Manners J ，Nolan L ，Simmonds PD ，Hayes MC ，Mead GM ... -  《-》

[Testicular cancer. Standard management leads to recovery in 90 to 95 percent of the cases].

Berger N ，Droz JP 《-》