Characteristics and Outcomes of a Cohort of 34 Patients with Testicular Germ Cell Tumors: A Single-Center Experience at Hassan II University Hospital of Fez
Introduction: Testicular germ cell tumors (TGCTs) are rare but account for more than 90% of testicular cancers. They mainly affect young men and have a high cure potential. This study aimed to describe the characteristics, management, and prognosis of TGCTs treated at Hassan II University Hospital of Fez. Materials and Methods: This monocentric retrospective study included 34 patients treated for TGCTs between May 2017 and December 2022. Epidemiological, clinical, therapeutic, and survival data were collected from medical records. Results: The mean age was 34 years (range: 16 - 66). Testicular enlargement was the main presenting symptom (75%). All diagnoses were confirmed by orchiectomy. According to the AJCC classification, 34% of patients were stage I, 28% stage II, and 38% stage III. Based on the IGCCCG prognostic classification, 50% of patients had a good prognosis and 50% had an intermediate prognosis. The BEP regimen was the most commonly used first-line chemotherapy. After a median follow-up of 4 years, overall survival (OS) was 90% and progression-free survival (PFS) was 85%. For seminomas, 4-year OS was 91% and PFS was 86%. For non-seminomatous tumors, OS was 85% and PFS was 80%. Conclusion: This series confirms the excellent prognosis of TGCTs in a Moroccan context, with survival outcomes comparable to international standards. It highlights the importance of standardized management according to stage and histological subtype.
References
[1]
Znaor, A., Skakkebæk, N.E., Rajpert‐De Meyts, E., Laversanne, M., Kuliš, T., Gurney, J., et al. (2019) Testicular Cancer Incidence Predictions in Europe 2010-2035: A Rising Burden Despite Population Ageing. InternationalJournalofCancer, 147, 820-828. https://doi.org/10.1002/ijc.32810
[2]
Moch, H., Cubilla, A.L., Humphrey, P.A., Reuter, V.E. and Ulbright, T.M. (2016) The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs—Part A: Renal, Penile, and Testicular Tumours. EuropeanUrology, 70, 93-105. https://doi.org/10.1016/j.eururo.2016.02.029
[3]
Hanna, N.H. and Einhorn, L.H. (2014) Testicular Cancer—Discoveries and Updates. NewEnglandJournalofMedicine, 371, 2005-2016. https://doi.org/10.1056/nejmra1407550
[4]
International Germ Cell Cancer Collaborative Group (1997) International Germ Cell Consensus Classification: A Prognostic Factor-Based Staging System for Metastatic Germ Cell Cancers. Journal of Clinical Oncology, 15, 594-603.
[5]
Albers, P., Albrecht, W., Algaba, F., Bokemeyer, C., Cohn-Cedermark, G., Fizazi, K., et al. (2023) EAU Guidelines on Testicular Cancer. European Association of Urology Guidelines. https://uroweb.org/guidelines/testicular-cancer
[6]
Parkin, D.M., Bray, F., Ferlay, J. and Pisani, P. (2005) Global Cancer Statistics, 2002. CA: ACancerJournalforClinicians, 55, 74-108. https://doi.org/10.3322/canjclin.55.2.74
[7]
Ferlay, J., Soerjomataram, I., Dikshit, R., Eser, S., Mathers, C., Rebelo, M., et al. (2014) Cancer Incidence and Mortality Worldwide: Sources, Methods and Major Patterns in GLOBOCAN 2012. InternationalJournalofCancer, 136, E359-E386. https://doi.org/10.1002/ijc.29210
[8]
Horwich, A., Shipley, J. and Huddart, R. (2006) Testicular Germ-Cell Cancer. TheLancet, 367, 754-765. https://doi.org/10.1016/s0140-6736(06)68305-0
[9]
Travis, W.D., Brambilla, E., Müller-Hermelink, H.K. and Harris, C.C. (2004) Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs. IARC Press.
[10]
Japanese Germ Cell Tumor Study Group (2021) Clinicopathological Characteristics of Testicular Germ Cell Tumors. International Journal of Urology, 28, 470-476.
[11]
Pettersson, A., Richiardi, L., Nordenskjold, A., Kaijser, M. and Akre, O. (2007) Age at Surgery for Undescended Testis and Risk of Testicular Cancer. NewEnglandJournalofMedicine, 356, 1835-1841. https://doi.org/10.1056/nejmoa067588
[12]
Fontaine, E., et al. (2002) Cryptorchidie et cancer du testicule. Progrès en Urologie, 12, 53-58.
[13]
Henderson, B.E., Benton, B., Jing, J., Yu, M.C. and Pike, M.C. (1979) Risk Factors for Cancer of the Testis in Young Men. InternationalJournalofCancer, 23, 598-602. https://doi.org/10.1002/ijc.2910230503
[14]
Wood, H.M. and Elder, J.S. (2009) Cryptorchidism and Testicular Cancer: Separating Fact from Fiction. JournalofUrology, 181, 452-461. https://doi.org/10.1016/j.juro.2008.10.074
[15]
Hemminki, K. and Li, X. (2004) Familial Risk in Testicular Cancer as a Clue to a Heritable and Environmental Aetiology. BritishJournalofCancer, 90, 1765-1770. https://doi.org/10.1038/sj.bjc.6601714
Martin, J.M., Panzarella, T., Zwahlen, D.R., Chung, P. and Warde, P. (2007) Evidence‐Based Guidelines for Following Stage 1 Seminoma. Cancer, 109, 2248-2256. https://doi.org/10.1002/cncr.22674
[18]
Moul, J.W., Paulson, D.F., Dodge, R.K. and Walther, P.J. (1990) Delay in Diagnosis and Survival in Testicular Cancer: Impact of Effective Therapy and Changes during 18 Years. JournalofUrology, 143, 520-523. https://doi.org/10.1016/s0022-5347(17)40007-3
[19]
Mostofi, F.K. and Sesterhenn, I.A. (1998) Histological Classification of Testis Tumors. Cancer, 83, 1553-1564.
[20]
Dieckmann, K. and Pichlmeier, U. (2004) Clinical Epidemiology of Testicular Germ Cell Tumors. WorldJournalofUrology, 22, 2-14. https://doi.org/10.1007/s00345-004-0398-8
[21]
Woodward, P.J., Schwab, C.M. and Sesterhenn, I.A. (2003) From the Archives of the AFIP: Extratesticular Scrotal Masses. RadioGraphics, 23, 215-240. https://doi.org/10.1148/rg.231025133
[22]
Albers, P., et al. (2008) Role of Imaging in Testicular Cancer. European Urology, 53, 478-496.
[23]
Gilligan, T., Lin, D.W., Aggarwal, R., Chism, D., Cost, N., Derweesh, I.H., et al. (2019) Testicular Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. JournaloftheNationalComprehensiveCancerNetwork, 17, 1529-1554. https://doi.org/10.6004/jnccn.2019.0058
[24]
Stephenson, A.J. and Gilligan, T.D. (2007) Neoadjuvant Chemotherapy and Orchiectomy in Advanced Germ Cell Tumors. Journal of Clinical Oncology, 25, 5614-5618.
[25]
Albers, P., Albrecht, W., Algaba, F., Bokemeyer, C., Cohn-Cedermark, G., Fizazi, K., et al. (2011) EAU Guidelines on Testicular Cancer: 2011 Update. EuropeanUrology, 60, 304-319. https://doi.org/10.1016/j.eururo.2011.05.038
[26]
Einhorn, L.H. (1997) Testicular Cancer: An Oncological Success Story. Clinical Cancer Research, 3, 2630-2632.
[27]
Travis, L.B., Fosså, S.D., Schonfeld, S.J., McMaster, M.L., Lynch, C.F., Storm, H., et al. (2005) Second Cancers among 40 576 Testicular Cancer Patients: Focus on Long-Term Survivors. JNCI: JournaloftheNationalCancerInstitute, 97, 1354-1365. https://doi.org/10.1093/jnci/dji278
[28]
Ozaki, Y., Narita, T., Hatakeyama, S., et al. (2022) Clinical Characteristics and Outcomes of Testicular Germ Cell Tumors: A Multicenter Japanese Study. International Journal of Clinical Oncology, 27, 1043-1051.
