Bilateral testicular germ cell tumors in the era of multimodal therapy Journal Article

Authors: Kopp, R. P.; Chevinsky, M.; Bernstein, M.; Bosl, G.; Motzer, R.; Bajorin, D.; Feldman, D.; Carver, B. S.; Sheinfeld, J.
Article Title: Bilateral testicular germ cell tumors in the era of multimodal therapy
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. © 2016
Journal Title: Urology
Volume: 103
ISSN: 0090-4295
Publisher: Elsevier Science, Inc.  
Date Published: 2017-05-01
Start Page: 154
End Page: 160
Language: English
DOI: 10.1016/j.urology.2016.10.018
PROVIDER: scopus
PUBMED: 27816603
PMCID: PMC5546215
Notes: Article -- Export Date: 1 June 2017 -- Source: Scopus
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MSK Authors
  1. Dean Bajorin
    404 Bajorin
  2. Robert Motzer
    745 Motzer
  3. Darren Richard Feldman
    171 Feldman
  4. Joel Sheinfeld
    195 Sheinfeld
  5. Brett Stewart Carver
    109 Carver
  6. George Bosl
    255 Bosl
  7. Ryan P Kopp
    7 Kopp