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Original article

Vol. 148 No. 2930 (2018)

Baseline characteristics and patterns of care in testicular cancer patients: first data from the Swiss Austrian German Testicular Cancer Cohort Study (SAG TCCS): This article was corrected and republished online on August 29, 2018. Please see Correction ‒ August 29, 2018.

  • Christian Rothermundt
  • Claudio Thurneysen
  • Richard Cathomas
  • Beat Müller
  • Walter Mingrone
  • Anita Hirschi-Blickenstorfer
  • Tobias Wehrhahn
  • Christian Ruf
  • Sacha I. Rothschild
  • Bettina Seifert
  • Angelika Terbuch
  • Thomas Grassmugg
  • Regina Woelky
  • Christian Fankhauser
  • Thomas Kunit
  • Natalie Fischer
  • Roman Inauen
  • Katrin Ziegler
  • Alan Haynes
  • Peter Jüni
  • Jeanine Kehl
  • Silke Gillessen
DOI
https://doi.org/10.4414/smw.2018.14640
Cite this as:
Swiss Med Wkly. 2018;148:w14640
Published
24.07.2018

Summary

BACKGROUND

The majority of germ cell tumour (GCT) patients can be cured by orchiectomy followed by active surveillance or subsequent systemic and/or local treatments. There are various guidelines for a structured follow-up including radiographic and clinical examinations.

OBJECTIVE

The Swiss Austrian German Testicular Cancer Cohort Study (SAG TCCS) prospectively evaluates follow-up, indicator of relapse and late toxicities. This is a descriptive analysis; we present baseline characteristics and treatment strategies for the first 299 patients with primary GCT or relapsed GCT after completion of treatment.

RESULTS

Of the patients included in this study, 192 (64.2%) had seminoma and 107 (35.8%) non-seminoma. Mean age was 41 years (standard deviation [SD] 11.7) for seminoma and 31 (SD 9.3) years for non-seminoma patients. Median tumour size was 3.5 cm (interquartile range 2.5­‒5.0 and 2.3‒4.5 in seminoma and non-seminoma, respectively) in both histological groups. Among seminoma patients, 81 (42.2%) had primary tumours >4cm; 154 (80.2%) seminoma patients had stage I, 26 (13.5%) stage II and 12 (6.3%) stage III disease. Fifty-seven (53.3%) non-seminoma tumours were stage I, 29 (27.1%) stage II and 21 (19.6%) stage III. Marker-positive disease was present in 58 (30.2%) seminoma patients and 78 (72.9%) non-seminoma patients. Of 154 stage I seminoma patients, 89 (57.8%) chose active surveillance and 65 (42.2%) adjuvant chemotherapy. Twenty-six (45.6%) stage I non-seminoma patients had high-risk disease; 23 of these were treated with adjuvant chemotherapy and 3 chose active surveillance. Among the 30 (52.6%) low risk stage I patients, all opted for active surveillance. Twelve (46.2%) stage II seminoma patients had radiotherapy, 14 (53.8%) were treated with three to four cycles of chemotherapy. All stage III seminoma patients, and all stage II and III non-seminoma patients were treated with three to four cycles of chemotherapy. Treatment decisions were made at the respective centre. Eleven patients did not receive therapy that conformed with guidelines.

CONCLUSION

It is important to enrol GCT patients in prospective studies in general, but also in follow-up studies to assess baseline characteristics, oncological outcome, and long-term toxicity and to validate the performance of follow-up schedules. This is the first time that the distribution of disease, detailed baseline characteristics and the respective treatment of men with GCT is collected in a prospective manner in German speaking countries (Switzerland, Austria and Germany) and therefore patterns of care have been evaluated. SAG TCCS results will inform on future modifications of surveillance schedules and follow-up procedures.

​

Trial registration number: NCT02229916 (Clinicaltrials.gov)

References

  1. Schweizerischer Krebsbericht. 2015. 14 ed: Bundesamt für Statistik (BFS); Nationales Institut für Krebsepidemiologie und -registrierung (NICER); Schweizer Kinderkrebsregister (SKKR); 2016.
  2. Rajpert-De Meyts E, McGlynn KA, Okamoto K, Jewett MA, Bokemeyer C. Testicular germ cell tumours. Lancet. 2016;387(10029):1762–74. doi:.https://doi.org/10.1016/S0140-6736(15)00991-5
  3. http://asrtch/nicer/.
  4. Hanna NH, Einhorn LH. Testicular cancer--discoveries and updates. N Engl J Med. 2014;371(21):2005–16. doi:.https://doi.org/10.1056/NEJMra1407550
  5. Cathomas R, Helbling D, Stenner F, Rothermundt C, Rentsch C, Shahin O, et al. Interdisciplinary evidence-based recommendations for the follow-up of testicular cancer patients: a joint effort. Swiss Med Wkly. 2010;140(25-26):356–69.
  6. Kollmannsberger C, Tandstad T, Bedard PL, Cohn-Cedermark G, Chung PW, Jewett MA, et al. Patterns of relapse in patients with clinical stage I testicular cancer managed with active surveillance. J Clin Oncol. 2015;33(1):51–7. doi:.https://doi.org/10.1200/JCO.2014.56.2116
  7. Oliver RT, Mason MD, Mead GM, von der Maase H, Rustin GJ, Joffe JK, et al.; MRC TE19 collaborators and the EORTC 30982 collaborators. Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial. Lancet. 2005;366(9482):293–300. doi:.https://doi.org/10.1016/S0140-6736(05)66984-X
  8. Mortensen MS, Bandak M, Kier MG, Lauritsen J, Agerbaek M, Holm NV, et al. Surveillance versus adjuvant radiotherapy for patients with high-risk stage I seminoma. Cancer. 2017;123(7):1212–8. doi:.https://doi.org/10.1002/cncr.30458
  9. Tandstad T, Dahl O, Cohn-Cedermark G, Cavallin-Stahl E, Stierner U, Solberg A, et al. Risk-adapted treatment in clinical stage I nonseminomatous germ cell testicular cancer: the SWENOTECA management program. J Clin Oncol. 2009;27(13):2122–8. doi:.. Corrected in: J Clin Oncol. 2010;28(8):1438 https://doi.org/10.1200/JCO.2008.18.8953
  10. Glaser SM, Vargo JA, Balasubramani GK, Beriwal S. Stage II Testicular Seminoma: Patterns of Care and Survival by Treatment Strategy. Clin Oncol (R Coll Radiol). 2016;28(8):513–21. doi:.https://doi.org/10.1016/j.clon.2016.02.008
  11. Horner MJRL, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2006. Bethesda, MD: National Cancer Institute; 2009.
  12. Verdecchia A, Francisci S, Brenner H, Gatta G, Micheli A, Mangone L, et al.; EUROCARE-4 Working Group. Recent cancer survival in Europe: a 2000-02 period analysis of EUROCARE-4 data. Lancet Oncol. 2007;8(9):784–96. doi:.https://doi.org/10.1016/S1470-2045(07)70246-2
  13. Travis LB, Beard C, Allan JM, Dahl AA, Feldman DR, Oldenburg J, et al. Testicular cancer survivorship: research strategies and recommendations. J Natl Cancer Inst. 2010;102(15):1114–30. doi:.https://doi.org/10.1093/jnci/djq216
  14. Hartmann M, Krege S, Souchon R, De Santis M, Gillessen S, Cathomas R ; Interdisziplinäre Arbeitsgruppe Hodentumore. Nachsorge von Patienten mit Hodentumoren [Follow-up of testicular germ cell cancer patients: interdisciplinary evidence-based recommendations]. Urologe A. 2011;50(7):830–5. Article in German. doi:.https://doi.org/10.1007/s00120-011-2556-0
  15. Cathomas R, Hartmann M, Krege S, Souchon R, Lorch A, Mayer F, et al.; interdisziplinäre Arbeitsgruppe Hodentumore. Interdisciplinary evidence-based recommendations for the follow-up of testicular germ cell cancer patients. Onkologie. 2011;34(1-2):59–64.
  16. Souchon R, Hartmann M, Krege S, Lorch A, Mayer F, De Santis M, et al. Interdisziplinäre evidenzbasierte Empfehlungen für die Nachbeobachtung von Patienten mit testikulärem Seminom im Frühstadium [Interdisciplinary evidence-based recommendations for the follow-up of early stage seminomatous testicular germ cell cancer patients]. Strahlenther Onkol. 2011;187(3):158–66. doi:.https://doi.org/10.1007/s00066-010-2227-x
  17. International Germ Cell Cancer Collaborative Group. International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers. J Clin Oncol. 1997;15(2):594–603. doi:.https://doi.org/10.1200/JCO.1997.15.2.594
  18. https://clinicaltrials.gov/ct2/show/NCT02375204?term=NCT02375204&rank=1.
  19. Fizazi K, Pagliaro L, Laplanche A, Fléchon A, Mardiak J, Geoffrois L, et al. Personalised chemotherapy based on tumour marker decline in poor prognosis germ-cell tumours (GETUG 13): a phase 3, multicentre, randomised trial. Lancet Oncol. 2014;15(13):1442–50. doi:.https://doi.org/10.1016/S1470-2045(14)70490-5
  20. Ruf CG, Isbarn H, Wagner W, Fisch M, Matthies C, Dieckmann KP. Changes in epidemiologic features of testicular germ cell cancer: age at diagnosis and relative frequency of seminoma are constantly and significantly increasing. Urol Oncol. 2014;32(1):33.e1–6. doi:.https://doi.org/10.1016/j.urolonc.2012.12.002
  21. Dieckmann KP, Dralle-Filiz I, Heinzelbecker J, Matthies C, Bedke J, Ellinger J, et al. Seminoma Clinical Stage 1 - Patterns of Care in Germany. Urol Int. 2016;96(4):390–8. doi:.https://doi.org/10.1159/000443214
  22. Woldu SL, Aydin AM, Rao AV, Hutchinson RC, Singla N, Clinton TN, et al. Differences at Presentation and Treatment of Testicular Cancer in Hispanic Men: Institutional and National Hospital-based Analyses. Urology. 2018;112:103–11. doi:.https://doi.org/10.1016/j.urology.2017.08.059
  23. Powles TB, Bhardwa J, Shamash J, Mandalia S, Oliver T. The changing presentation of germ cell tumours of the testis between 1983 and 2002. BJU Int. 2005;95(9):1197–200. doi:.https://doi.org/10.1111/j.1464-410X.2005.05504.x
  24. Daugaard G, Gundgaard MG, Mortensen MS, Agerbæk M, Holm NV, Rørth M, et al. Surveillance for stage I nonseminoma testicular cancer: outcomes and long-term follow-up in a population-based cohort. J Clin Oncol. 2014;32(34):3817–23. doi:.https://doi.org/10.1200/JCO.2013.53.5831
  25. Germà-Lluch JR, Garcia del Muro X, Maroto P, Paz-Ares L, Arranz JA, Gumà J, et al.; Spanish Germ-Cell Cancer Group (GG). Clinical pattern and therapeutic results achieved in 1490 patients with germ-cell tumours of the testis: the experience of the Spanish Germ-Cell Cancer Group (GG). Eur Urol. 2002;42(6):553–62, discussion 562–3. doi:.https://doi.org/10.1016/S0302-2838(02)00439-6
  26. Warde P, Specht L, Horwich A, Oliver T, Panzarella T, Gospodarowicz M, et al. Prognostic factors for relapse in stage I seminoma managed by surveillance: a pooled analysis. J Clin Oncol. 2002;20(22):4448–52. doi:.https://doi.org/10.1200/JCO.2002.01.038
  27. Tandstad T, Ståhl O, Dahl O, Haugnes HS, Håkansson U, Karlsdottir Å, et al.; SWENOTECA. Treatment of stage I seminoma, with one course of adjuvant carboplatin or surveillance, risk-adapted recommendations implementing patient autonomy: a report from the Swedish and Norwegian Testicular Cancer Group (SWENOTECA). Ann Oncol. 2016;27(7):1299–304. doi:.https://doi.org/10.1093/annonc/mdw164
  28. Zengerling F, Kunath F, Jensen K, Ruf C, Schmidt S, Spek A. Prognostic factors for tumor recurrence in patients with clinical stage I seminoma undergoing surveillance-A systematic review. Urol Oncol. 2017;S1078-1439(17)30331-9. Epub agead of print.
  29. Aparicio J, Maroto P, del Muro XG, Gumà J, Sánchez-Muñoz A, Margelí M, et al. Risk-adapted treatment in clinical stage I testicular seminoma: the third Spanish Germ Cell Cancer Group study. J Clin Oncol. 2011;29(35):4677–81. doi:.https://doi.org/10.1200/JCO.2011.36.0503
  30. Albany C, Einhorn L. Pitfalls in management of patients with germ cell tumors and slight elevation of serum α-fetoprotein. J Clin Oncol. 2014;32(19):2114–5. doi:.https://doi.org/10.1200/JCO.2014.56.0607
  31. Wymer KM, Daneshmand S, Pierorazio PM, Pearce SM, Harris KT, Eggener SE. Mildly elevated serum alpha-fetoprotein (AFP) among patients with testicular cancer may not be associated with residual cancer or need for treatment. Ann Oncol. 2017;28(4):899–902.
  32. Gilligan TD, Seidenfeld J, Basch EM, Einhorn LH, Fancher T, Smith DC, et al.; American Society of Clinical Oncology. American Society of Clinical Oncology Clinical Practice Guideline on uses of serum tumor markers in adult males with germ cell tumors. J Clin Oncol. 2010;28(20):3388–404. doi:.https://doi.org/10.1200/JCO.2009.26.4481
  33. Tandstad T, Smaaland R, Solberg A, Bremnes RM, Langberg CW, Laurell A, et al. Management of seminomatous testicular cancer: a binational prospective population-based study from the Swedish norwegian testicular cancer study group. J Clin Oncol. 2011;29(6):719–25. doi:.https://doi.org/10.1200/JCO.2010.30.1044
  34. Fischer S, Tandstad T, Wheater M, Porfiri E, Fléchon A, Aparicio J, et al. Outcome of Men With Relapse After Adjuvant Carboplatin for Clinical Stage I Seminoma. J Clin Oncol. 2017;35(2):194–200. doi:.https://doi.org/10.1200/JCO.2016.69.0958
  35. Oliver RT, Mason MD, Mead GM, von der Maase H, Rustin GJ, Joffe JK, et al.; MRC TE19 collaborators and the EORTC 30982 collaborators. Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial. Lancet. 2005;366(9482):293–300. doi:.https://doi.org/10.1016/S0140-6736(05)66984-X
  36. Oliver RT, Mead GM, Rustin GJ, Joffe JK, Aass N, Coleman R, et al. Randomized trial of carboplatin versus radiotherapy for stage I seminoma: mature results on relapse and contralateral testis cancer rates in MRC TE19/EORTC 30982 study (ISRCTN27163214). J Clin Oncol. 2011;29(8):957–62. doi:.https://doi.org/10.1200/JCO.2009.26.4655
  37. Gillessen S, De Santis M, Rothermundt C. On Nonharming: The Debate Continues in Stage I Testicular Cancer. J Clin Oncol. 2015;33(20):2319–20. doi:.https://doi.org/10.1200/JCO.2015.61.1632
  38. Oldenburg J, Aparicio J, Beyer J, Cohn-Cedermark G, Cullen M, Gilligan T, et al.; On behalf of: SWENOTECA (Swedish Norwegian Testicular Cancer group), the Italian Germ Cell Cancer Group (IGG), Spanish Germ Cell Cancer Group (SGCCG). Personalizing, not patronizing: the case for patient autonomy by unbiased presentation of management options in stage I testicular cancer. Ann Oncol. 2015;26(5):833–8. doi:.https://doi.org/10.1093/annonc/mdu514
  39. Fosså SD, Cvancarova M, Chen L, Allan AL, Oldenburg J, Peterson DR, et al. Adverse prognostic factors for testicular cancer-specific survival: a population-based study of 27,948 patients. J Clin Oncol. 2011;29(8):963–70. doi:.https://doi.org/10.1200/JCO.2010.32.3204
  40. Giannatempo P, Greco T, Mariani L, Nicolai N, Tana S, Farè E, et al. Radiotherapy or chemotherapy for clinical stage IIA and IIB seminoma: a systematic review and meta-analysis of patient outcomes. Ann Oncol. 2015;26(4):657–68. doi:.https://doi.org/10.1093/annonc/mdu447
  41. Gurney J, Shaw C, Stanley J, Signal V, Sarfati D. Cannabis exposure and risk of testicular cancer: a systematic review and meta-analysis. BMC Cancer. 2015;15(1):897. doi:.https://doi.org/10.1186/s12885-015-1905-6
  42. Daling JR, Doody DR, Sun X, Trabert BL, Weiss NS, Chen C, et al. Association of marijuana use and the incidence of testicular germ cell tumors. Cancer. 2009;115(6):1215–23. doi:.https://doi.org/10.1002/cncr.24159
  43. Trabert B, Sigurdson AJ, Sweeney AM, Strom SS, McGlynn KA. Marijuana use and testicular germ cell tumors. Cancer. 2011;117(4):848–53. doi:.https://doi.org/10.1002/cncr.25499
  44. Lacson JC, Carroll JD, Tuazon E, Castelao EJ, Bernstein L, Cortessis VK. Population-based case-control study of recreational drug use and testis cancer risk confirms an association between marijuana use and nonseminoma risk. Cancer. 2012;118(21):5374–83. doi:.https://doi.org/10.1002/cncr.27554
  45. Callaghan RC, Allebeck P, Akre O, McGlynn KA, Sidorchuk A. Cannabis Use and Incidence of Testicular Cancer: A 42-Year Follow-up of Swedish Men between 1970 and 2011. Cancer Epidemiol Biomarkers Prev. 2017;26(11):1644–52. doi:.https://doi.org/10.1158/1055-9965.EPI-17-0428

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