Materiały źródłowe

• #1 Testicular Cancer: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/279007-overview

  Primary testicular tumors are the most common solid malignant tumor in men 20 to 35 years of age in the United States. For unknown reasons, the incidence of this cancer principally, testicular seminomas increased during the last century. Over the past decade, the incidence of testicular cancer has risen approximately 1.2% per year, although the rate of increase has been slowing. Germ cell cancers account for more than 90% of all testicular cancers. Approximately 9,000 new cases have been diagnosed in the United States every year, although only about 400 deaths have occurred annually. […] Testicular cancers are an uncommon malignancy, representing only 0.5% of all new cancer cases in the United States. The American Cancer Society (ACS) estimates that about 9190 new cases of testicular cancer will be diagnosed during 2023 in the United States. The lifetime chance of developing testicular cancer is about one in 250 and the risk of dying is very low about one in 5,000. Most cases occur in men aged 20-34 years; the median age at diagnosis is approximately 32 years.

• #2 Systemic therapy for primary and extragonadal germ cell tumors: prognosis and nuances of treatment – Siddiqui – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/29436/html

  Testicular germ cell tumors are the most common solid tumors in young men between the ages of 20 and 34, with an estimated 9,310 cases diagnosed in the United States in 2018, with approximately 400 deaths. […] In general, testicular germ cell tumors carry an excellent prognosis, with a 5-year survival rate of approximately 95%. […] An increasing incidence of testicular cancers has been observed, for uncertain reasons. […] Testicular germ cell tumors account for the vast majority of malignant tumors arising in the testes; these tumors also occasionally arise in extragonadal sites, such as the retroperitoneum and anterior mediastinum. […] Risk factors for testicular cancer include cryptorchidism, family history, and prior history of testicular cancer. […] A well-established standard of care exists for the majority of testicular germ cell tumors, leading to a high overall survival rate.

• #3 Epidemiology and risk factors for testicular cancer – UpToDate

  https://www.uptodate.com/contents/epidemiology-and-risk-factors-for-testicular-cancer

  Epidemiology and risk factors for testicular cancer […] Germ cell tumors (GCTs) account for 95 percent of testicular cancers and include both seminomas and nonseminomatous germ cell tumors (NSGCTs). […] The epidemiology and risk factors for the development of testicular germ cell tumors are discussed here. […] Testicular cancer is the most common solid malignancy affecting males between the ages of 15 and 35. In the United States, approximately 9800 males are diagnosed with testicular cancer each year. […] Worldwide, there are approximately 75,000 cases of testicular cancer and over 9000 deaths per year. […] Geographic areas with the lowest incidence of testicular GCT in 2020 include Africa and Asia (age standardized incidence rate [ASIR] of 0 to 1.7), areas with an intermediate incidence include North America and Eastern Europe (ASIR of 1.7 to 5.8), and areas with the highest incidence include the Scandinavian countries, Western Europe, parts of South America, and Australia-New Zealand (ASIR of 5.8 to 13.2). […] The incidence of testicular cancer has been increasing globally, but the cause is unclear.

• #4 Germ Cell Tumors – Holland-Frei Cancer Medicine – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK13572/

  Germ cell tumors (GCTs) are rare in children and occur with an incidence of 2.4 cases per million children per year; this number accounts for less than 3% of all pediatric malignancies. This incidence is, however, underestimated, because most tumor registries are biased toward the inclusion of malignant types and tend to exclude most mature teratomas. The distribution of GCTs with age follows a bimodal pattern: peak incidences of GCTs occur during the first 3 years of life and in late adolescence. In general, there is a higher overall incidence of GCTs among girls and young women, although boys and young men are more at risk for malignant GCTs. The only known predisposing factors for GCTs in male pediatric patients are cryptorchidism and gonadal dysgenesis. […] GCTs have an infiltrative growth pattern and can disseminate by lymphogenous and hematogenous routes. The most common sites of hematogenous metastases are the lungs and liver. Serologic markers are very useful for diagnosis, monitoring of response, and prediction of recurrence. Serum -fetoprotein concentrations are usually elevated in tumors with YST components. […] Surveillance is appropriate for 3 to 5 years after surgical treatment, and should include monitoring of serum -fetoprotein concentrations.

• #5 Epidemiology and risk factors for testicular cancer – UpToDate

  https://www.uptodate.com/contents/epidemiology-and-risk-factors-for-testicular-cancer

  Epidemiology and risk factors for testicular cancer […] Germ cell tumors (GCTs) account for 95 percent of testicular cancers and include both seminomas and nonseminomatous germ cell tumors (NSGCTs). […] The epidemiology and risk factors for the development of testicular germ cell tumors are discussed here. […] Testicular cancer is the most common solid malignancy affecting males between the ages of 15 and 35. In the United States, approximately 9800 males are diagnosed with testicular cancer each year. […] Worldwide, there are approximately 75,000 cases of testicular cancer and over 9000 deaths per year. […] Geographic areas with the lowest incidence of testicular GCT in 2020 include Africa and Asia (age standardized incidence rate [ASIR] of 0 to 1.7), areas with an intermediate incidence include North America and Eastern Europe (ASIR of 1.7 to 5.8), and areas with the highest incidence include the Scandinavian countries, Western Europe, parts of South America, and Australia-New Zealand (ASIR of 5.8 to 13.2). […] The incidence of testicular cancer has been increasing globally, but the cause is unclear.

• #6 Human Germ Cell Tumors are Developmental Cancers: Impact of Epigenetics on Pathobiology and Clinic

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6359418/

  A number of different cell types can be found in the testis (germ cells, Sertoli cells, Leydig cells, mesenchymal cells, mesothelial cells, among others); thus, and despite being a relatively small organ, the testis may give rise to a large variety of neoplasms. […] Nonetheless, more than 95% of testicular neoplasms are derived from germ cells arrested in their differentiationthe testicular germ cell tumors (TGCTs) meaning that global epidemiological trends for testicular cancer mostly refer to this group of neoplasms. […] The European Cancer Registry-Based Study on Survival and Care of Cancer Patients (EUROCARE) reports markedly distinct age-adjusted incidence rates of GCTs in Europe for males and females (64 per 1,000,000 versus 4 per 1,000,000, respectively). […] TGCTs show a bell-shaped distribution of cases with a peak around 30 years, with SEs overall occurring 10 years later than NSTs.

• #7 Human Germ Cell Tumors are Developmental Cancers: Impact of Epigenetics on Pathobiology and Clinic

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6359418/

  In the United States incidence rates were of 56 per 1,000,000 and of only 10 per 1,000,000 in Caucasian and African-American males, respectively. […] Incidence of GCTs overall has been increasing, especially at the expense of TGCTs. […] Overall, testicular cancer is not a common disease, ranking as only the 21st most incident neoplasm in men worldwide, in 2018 (with 71,105 new cases and an age standardized rate of 1.7 per 100,000). […] However, a closer look at the figures shows it also represents the most incident and most prevalent neoplasm in males aged 15-39 years old, at global level, with an age-standardized incidence rate of 2.7 per 100,000 in 2018 and a five-year prevalence of 150,377 cases. […] Moreover, incidence is on the rise in most populations, with a total of 85,635 new cases expected for 2040 (14,530 more that in 2018, representing a 20.4% increase), and a total of 13,288 estimated deaths (3781 more than in 2018, a 39.8% increase), according to Globocan 2018 predictions.

• #8 Human Germ Cell Tumors are Developmental Cancers: Impact of Epigenetics on Pathobiology and Clinic

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6359418/

  Similar data is replicated by the Surveillance, Epidemiology, and End Results Program (SEER) database; despite representing only 0.5% of all new cancer cases in the United States, incidence rates have been rising 0.8% per year over the last 10 years and the number of new cases of testicular cancer was 5.7 per 100,000 males per year according to 2011-2015 registries. […] Importantly, variation in testicular cancer incidence rates worldwide is remarkable (29-fold variation, being higher in Europe, Australia and the United States), and mortality-to-incidence ratio is reported to be higher in underdeveloped regions of the globe, probably due to less access to proper healthcare facilities, diagnostic tools, and multimodal treatments. […] All in all, there are a number of reasons to remain focused on TGCTs: besides the rising incidence in part explained by Western lifestyle, about 15-20% of patients with disseminated disease experience disease recurrence (with late relapses displaying poor prognosis); in spite of exquisite sensitivity to cytotoxic agents, resistance to cisplatin treatment eventually emerges in some cases, by still elusive mechanisms; and also the diagnosis of cancer in such young patients (with long life-expectancy) who undergo chemo and radiotherapy raises concerns over quality of life, fertility and enduring treatment-related side effects, such as the emergence of second tumors and cardiovascular disease, and merit proper action to prevent them.

• #9 Testicular Cancer: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/279007-overview

  In the United States, the incidence increased by 100% from 1988 to 2001. Diagnoses of seminomas increased 124% during that period and diagnoses of nonseminomas increased by 64%. No significant increase occurred in the incidence of early-stage disease in proportion to all diagnoses in this population, indicating that the increase was not due to more widespread screening or earlier detection. The rate of increase has slowed in recent years. […] According to Surveillance, Epidemiology, and End Results (SEER) data from 18 geographic areas, the age-adjusted annual incidence of testicular cancer from 2016-2020 was 6.0 per 100,000 men. However, the incidence varies widely by race/ethnicity. […] Studies of testicular cancer in selected global populations from 1973-2007 have shown a clear trend toward an increased incidence in most populations evaluated. In recent years, however, rates have plateaued in some areas and even decreased in a few.

• #10 Testicular Cancer: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/279007-overview

  Epidemiologic observations have suggested that environmental factors are instrumental in determining risk for testicular cancers. However, epidemiologic evidence does not consistently support any specific risk factor. […] The incidence of testicular cancer is fivefold higher in whites than in African Americans; however, African Americans tend to present with higher-grade disease and have much worse prognosis than whites. […] A review of SEER data found that in Hispanic Whites ages 15 to 39 years, the annual incidence of testicular germ cell tumors increased 58% between 1992 and 2010, from 7.18 to 11.34 cases per 100,000. By comparison, during that period the incidence in non-Hispanic White young adults increased 7%, from 12.41 to 13.22 cases per 100,000. […] Testicular cancer can occur at any age but is most common between the ages of 15 and 35 years; about 50% of cases occur in men 20-34 years old. There is also a secondary peak in incidence after age 60.

• #11 Testicular Cancer Incidence Rising in the U.S., Especially Among Hispanic Men – NCI

  https://dceg.cancer.gov/news-events/news/2025/tgct-hispanic-men

  Incidence of testicular germ cell tumors (TGCTs), one of the most common cancers among young men in the United States, has increased significantly over the past few decades. […] However, new evidence indicates that, for the first time, incidence rates among Hispanic men have risen to match those of NHW men, marking a significant development in the descriptive epidemiology of testicular cancer in the U.S. […] The investigators found that the age-standardized incidence rate of TGCT increased from 4.71 per 100,000 person-years in 1992 to 6.22 per 100,000 person-years in 2021. […] While rates stabilized among NHW men, the greatest increases were observed among Hispanic men, whose incidence rate increased by an average annual percent change of 3.03%. […] The study findings underscore the need for continued investigation into the factors contributing to the rising incidence of TGCT in most racial/ethnic groups in the U.S., especially Hispanic men.

• #12 Germ Cell Tumors – Holland-Frei Cancer Medicine – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK13572/

  Germ cell tumors (GCTs) are rare in children and occur with an incidence of 2.4 cases per million children per year; this number accounts for less than 3% of all pediatric malignancies. This incidence is, however, underestimated, because most tumor registries are biased toward the inclusion of malignant types and tend to exclude most mature teratomas. The distribution of GCTs with age follows a bimodal pattern: peak incidences of GCTs occur during the first 3 years of life and in late adolescence. In general, there is a higher overall incidence of GCTs among girls and young women, although boys and young men are more at risk for malignant GCTs. The only known predisposing factors for GCTs in male pediatric patients are cryptorchidism and gonadal dysgenesis. […] GCTs have an infiltrative growth pattern and can disseminate by lymphogenous and hematogenous routes. The most common sites of hematogenous metastases are the lungs and liver. Serologic markers are very useful for diagnosis, monitoring of response, and prediction of recurrence. Serum -fetoprotein concentrations are usually elevated in tumors with YST components. […] Surveillance is appropriate for 3 to 5 years after surgical treatment, and should include monitoring of serum -fetoprotein concentrations.

• #13 Testicular Cancer: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/279007-overview

  Epidemiologic observations have suggested that environmental factors are instrumental in determining risk for testicular cancers. However, epidemiologic evidence does not consistently support any specific risk factor. […] The incidence of testicular cancer is fivefold higher in whites than in African Americans; however, African Americans tend to present with higher-grade disease and have much worse prognosis than whites. […] A review of SEER data found that in Hispanic Whites ages 15 to 39 years, the annual incidence of testicular germ cell tumors increased 58% between 1992 and 2010, from 7.18 to 11.34 cases per 100,000. By comparison, during that period the incidence in non-Hispanic White young adults increased 7%, from 12.41 to 13.22 cases per 100,000. […] Testicular cancer can occur at any age but is most common between the ages of 15 and 35 years; about 50% of cases occur in men 20-34 years old. There is also a secondary peak in incidence after age 60.

• #14 Human Germ Cell Tumors are Developmental Cancers: Impact of Epigenetics on Pathobiology and Clinic

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6359418/

  A number of different cell types can be found in the testis (germ cells, Sertoli cells, Leydig cells, mesenchymal cells, mesothelial cells, among others); thus, and despite being a relatively small organ, the testis may give rise to a large variety of neoplasms. […] Nonetheless, more than 95% of testicular neoplasms are derived from germ cells arrested in their differentiationthe testicular germ cell tumors (TGCTs) meaning that global epidemiological trends for testicular cancer mostly refer to this group of neoplasms. […] The European Cancer Registry-Based Study on Survival and Care of Cancer Patients (EUROCARE) reports markedly distinct age-adjusted incidence rates of GCTs in Europe for males and females (64 per 1,000,000 versus 4 per 1,000,000, respectively). […] TGCTs show a bell-shaped distribution of cases with a peak around 30 years, with SEs overall occurring 10 years later than NSTs.

• #15 EAU Guidelines on Testicular Cancer – Uroweb

  https://uroweb.org/guidelines/testicular-cancer/chapter/epidemiology-aetiology-amp-pathology

  Testicular cancer represents 1% of adult neoplasms and 5% of urological tumours, with three to ten new cases per 100,000 males/per year in Western societies. The incidence of TC has increased during recent decades, predominantly in industrialised countries, and it continues to rise. At diagnosis, 1-2% are bilateral and 90-95% of cases are germ cell tumours (GCT). The peak incidence is in the third decade of life for non-seminomatous germ cell tumour (NSGCT) and mixed GCT patients, and in the fourth decade for seminoma testis (ST) patients. In 5% of GCT patients, the primary site is at an extragonadal location. […] Risk factors for GCNIS-derived GCTs are components of the testicular dysgenesis syndrome, which encompasses cryptorchidism, hypospadias, decreased spermatogenesis and impaired fertility or disorders of sex development. Additional risk factors include a family history of TC among first-degree relatives and the presence of a contralateral testicular tumour or GCNIS although the risk was lower if TC patients previously had received platinum-based chemotherapy. Genome-wide association studies revealed detectable susceptibility loci leading to an increased relative risk to develop TC.

• #16 Germ Cell Tumors – Holland-Frei Cancer Medicine – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK13572/

  Germ cell tumors (GCTs) are rare in children and occur with an incidence of 2.4 cases per million children per year; this number accounts for less than 3% of all pediatric malignancies. This incidence is, however, underestimated, because most tumor registries are biased toward the inclusion of malignant types and tend to exclude most mature teratomas. The distribution of GCTs with age follows a bimodal pattern: peak incidences of GCTs occur during the first 3 years of life and in late adolescence. In general, there is a higher overall incidence of GCTs among girls and young women, although boys and young men are more at risk for malignant GCTs. The only known predisposing factors for GCTs in male pediatric patients are cryptorchidism and gonadal dysgenesis. […] GCTs have an infiltrative growth pattern and can disseminate by lymphogenous and hematogenous routes. The most common sites of hematogenous metastases are the lungs and liver. Serologic markers are very useful for diagnosis, monitoring of response, and prediction of recurrence. Serum -fetoprotein concentrations are usually elevated in tumors with YST components. […] Surveillance is appropriate for 3 to 5 years after surgical treatment, and should include monitoring of serum -fetoprotein concentrations.

• #17 Extragonadal Germ Cell Tumors: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/278174-overview

  Extragonadal germ cell tumors (EGGCTs) represent approximately 5% of all germ cell tumor (GCTs), with an incidence around 1.9 3.4 per million population. […] In Norway, a study by Dueland et al estimated the incidence of extragonadal germ cell tumor at 0.5 per 100,000 population per year. […] In adults, only benign extragonadal germ cell tumors (teratomas) occur at equal frequency in both sexes; more than 90% of malignant extragonadal germ cell tumors occur in males. […] Extragonadal germinal cell syndromes are rare tumors that predominantly affect young males. Pediatric germ cell tumors (GCTs) account for approximately 3.5% of cancers in children under the age of 15 years and increase in frequency to 13.9% among 15- to 19-year-olds. […] Racial disparities in mortality rates among males with GCTs have been reported. In a review of Surveillance, Epidemiology, and End Results (SEER) Program data, mortality rates were significantly higher in Hispanic and Asian/Pacific Island males than in White males.

• #18 Germ Cell Tumors – Holland-Frei Cancer Medicine – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK13572/

  Germ cell tumors (GCTs) are rare in children and occur with an incidence of 2.4 cases per million children per year; this number accounts for less than 3% of all pediatric malignancies. This incidence is, however, underestimated, because most tumor registries are biased toward the inclusion of malignant types and tend to exclude most mature teratomas. The distribution of GCTs with age follows a bimodal pattern: peak incidences of GCTs occur during the first 3 years of life and in late adolescence. In general, there is a higher overall incidence of GCTs among girls and young women, although boys and young men are more at risk for malignant GCTs. The only known predisposing factors for GCTs in male pediatric patients are cryptorchidism and gonadal dysgenesis. […] GCTs have an infiltrative growth pattern and can disseminate by lymphogenous and hematogenous routes. The most common sites of hematogenous metastases are the lungs and liver. Serologic markers are very useful for diagnosis, monitoring of response, and prediction of recurrence. Serum -fetoprotein concentrations are usually elevated in tumors with YST components. […] Surveillance is appropriate for 3 to 5 years after surgical treatment, and should include monitoring of serum -fetoprotein concentrations.

• #19 Epidemiology of Germ Cell Tumors | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-642-38971-9_2

  Pediatric malignant germ cell tumors (GCTs) represent approximately 3 % of childhood cancers. Incidence is increasing in certain subgroups, and the etiology remains poorly understood. Evidence suggests that GCTs, including those in adults, are initiated in utero. Thus, alterations in normal embryonic development are likely to be especially relevant to GCT etiology. Potential risk factors that have been evaluated for pediatric GCT include parental demographic characteristics; in utero exposure to hormones and pesticides; maternal reproductive history; parental smoking, occupation, and alcohol consumption; and congenital abnormalities; however, none has emerged as a consistent risk factor. Family history of testicular cancer and cryptorchidism are two well-established risk factors for adult testicular GCT. Genetic susceptibility is of particular interest for adult TGCTs given the strong evidence supporting a hereditary basis for this cancer, and recent genome-wide association studies have identified susceptibility alleles for TGCT in several genes with relevance to normal germ cell development. Malignant GCTs in adult females are extremely rare with incidence rates well below 1 per 100,000 women in most countries; therefore, little is known about the etiology of these tumors. […] The Inter-Regional, Epidemiological Study of Childhood Cancer (IRESCC): case-control study in children with germ cell tumours. […] Trends in incidence and survival of pediatric and adolescent patients with germ cell tumors in the United States, 1975 to 2006.

• #20

  https://link.springer.com/article/10.1007/s00345-004-0398-8

  Clinical epidemiology is sometimes called the basic science of clinical medicine. In terms of the pathogenesis of testicular germ cell tumors (GCTs), clinical epidemiology analyzes suspected risk factors. The present review highlights the risk factors established so far and briefly summarizes those factors currently under investigation. […] So far, undescended testis (UDT), contralateral testicular GCT and familial testis cancer are established risk factors attaining high levels of evidence (levels IIII a). In a meta-analysis of 21 studies exploring the association of UDT with GCT risk, an over-all relative risk (RR) of 4.8 (95% confidence interval 4.05.7) was found. Contralateral testicular GCT involves a roughly 25-fold increased RR of GCT, while familial testis cancer constitutes a RR of 310.

• #21 Classification, Epidemiology and Therapies for Testicular Germ Cell Tumours

  https://www.scitechnol.com/peer-review/classification-epidemiology-and-therapies-for-testicular-germ-cell-tumours-JYah.php?article_id=4973

  Testicular Germ Cell Tumours (TGCTs) have come to be well defined and managed, thanks to a number of international consortia and collaborations. The incidence of TGCTs continues to rise, with a growing number of risk factors which are discussed in this article. […] The incidence of testicular cancer has been increasing in the last decades, especially in industrialized countries. Testicular cancer now represents 1% of male malignancies and 5% of urological tumours. In 90-95% of cases, the histology is germ cell tumour, with bilateral disease in 1-2%. Non-seminomas have a peak incidence in the third decade, and seminomas peak in the fourth decade. A specific genetic marker has been described in all histological types of TCGTs; an isochromosome of the short arm of chromosome 12 i(12p). In addition, a deregulation in the pluripotent program of foetal germ cells is likely responsible for the development of TCGTs. There is overlap in the development of seminoma and embryonal carcinoma, demonstrated by genome-wide expression analysis and the detection of alpha-fetoprotein mRNA in some atypical seminoma. Risk factors for testicular tumours are components of the testicular dysgenesis syndrome. These include cryptorchidism, hypospadias and sub- or infertility indicating decreased spermatogenesis. The risk of testicular cancer in the undescended testicle increases by 4-13 times, with up to 10% of all testicular tumours arising from an undescended testicle. Additional risk factors include history of testicular tumour in a first-degree relative, which increases risk by up to eight times, and the presence of contralateral tumour or testicular intraepithelial neoplasia (TIN). Extremes of height seem to influence risk, with tall men at a higher risk of TGCTs and short stature protecting against it. Exposure to diethylstilboestrol (oestrogen) in utero confers a relative risk of up to 5.3% for testicular cancer. Additional risk factors such as Marijuana exposure, vasectomy, trauma, mumps and Human Immunodeficiency Virus (HIV) continue to be evaluated.

• #22 EAU Guidelines on Testicular Cancer – Uroweb

  https://uroweb.org/guidelines/testicular-cancer/chapter/epidemiology-aetiology-amp-pathology

  Testicular cancer represents 1% of adult neoplasms and 5% of urological tumours, with three to ten new cases per 100,000 males/per year in Western societies. The incidence of TC has increased during recent decades, predominantly in industrialised countries, and it continues to rise. At diagnosis, 1-2% are bilateral and 90-95% of cases are germ cell tumours (GCT). The peak incidence is in the third decade of life for non-seminomatous germ cell tumour (NSGCT) and mixed GCT patients, and in the fourth decade for seminoma testis (ST) patients. In 5% of GCT patients, the primary site is at an extragonadal location. […] Risk factors for GCNIS-derived GCTs are components of the testicular dysgenesis syndrome, which encompasses cryptorchidism, hypospadias, decreased spermatogenesis and impaired fertility or disorders of sex development. Additional risk factors include a family history of TC among first-degree relatives and the presence of a contralateral testicular tumour or GCNIS although the risk was lower if TC patients previously had received platinum-based chemotherapy. Genome-wide association studies revealed detectable susceptibility loci leading to an increased relative risk to develop TC.

• #23 EAU Guidelines on Testicular Cancer – Uroweb

  https://uroweb.org/guidelines/testicular-cancer/chapter/epidemiology-aetiology-amp-pathology

  Testicular cancer represents 1% of adult neoplasms and 5% of urological tumours, with three to ten new cases per 100,000 males/per year in Western societies. The incidence of TC has increased during recent decades, predominantly in industrialised countries, and it continues to rise. At diagnosis, 1-2% are bilateral and 90-95% of cases are germ cell tumours (GCT). The peak incidence is in the third decade of life for non-seminomatous germ cell tumour (NSGCT) and mixed GCT patients, and in the fourth decade for seminoma testis (ST) patients. In 5% of GCT patients, the primary site is at an extragonadal location. […] Risk factors for GCNIS-derived GCTs are components of the testicular dysgenesis syndrome, which encompasses cryptorchidism, hypospadias, decreased spermatogenesis and impaired fertility or disorders of sex development. Additional risk factors include a family history of TC among first-degree relatives and the presence of a contralateral testicular tumour or GCNIS although the risk was lower if TC patients previously had received platinum-based chemotherapy. Genome-wide association studies revealed detectable susceptibility loci leading to an increased relative risk to develop TC.

• #24

  https://link.springer.com/article/10.1007/s00345-004-0398-8

  There is also some evidence for HIV infection being a predisposing factor for GCT (level IV a). […] The estrogen excess theory implies high estrogen levels during the first trimester of pregnancy. […] Another novel theory is the childhood nutrition hypothesis. This concept postulates a modulating or catalyzing effect by high dietary intake during childhood on the pathogenesis of testicular GCT. […] Thus, the sum of evidence corresponds to level III b.

• #25 Epidemiology of Germ Cell Tumors | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-642-38971-9_2

  Pediatric malignant germ cell tumors (GCTs) represent approximately 3 % of childhood cancers. Incidence is increasing in certain subgroups, and the etiology remains poorly understood. Evidence suggests that GCTs, including those in adults, are initiated in utero. Thus, alterations in normal embryonic development are likely to be especially relevant to GCT etiology. Potential risk factors that have been evaluated for pediatric GCT include parental demographic characteristics; in utero exposure to hormones and pesticides; maternal reproductive history; parental smoking, occupation, and alcohol consumption; and congenital abnormalities; however, none has emerged as a consistent risk factor. Family history of testicular cancer and cryptorchidism are two well-established risk factors for adult testicular GCT. Genetic susceptibility is of particular interest for adult TGCTs given the strong evidence supporting a hereditary basis for this cancer, and recent genome-wide association studies have identified susceptibility alleles for TGCT in several genes with relevance to normal germ cell development. Malignant GCTs in adult females are extremely rare with incidence rates well below 1 per 100,000 women in most countries; therefore, little is known about the etiology of these tumors. […] The Inter-Regional, Epidemiological Study of Childhood Cancer (IRESCC): case-control study in children with germ cell tumours. […] Trends in incidence and survival of pediatric and adolescent patients with germ cell tumors in the United States, 1975 to 2006.

• #26 Surveillance for stage I testicular germ cell tumors following orchiectomy – UpToDate

  https://www.uptodate.com/contents/surveillance-for-stage-i-testicular-germ-cell-tumors-following-orchiectomy

  Surveillance for stage I testicular germ cell tumors following orchiectomy […] Testicular germ cell tumor (GCT) is a highly curable cancer, with five-year survival rates of over 95 percent. For most patients with stage I GCTs who are treated with orchiectomy, surveillance is the preferred approach given low relapse rates, excellent long-term overall survival, and avoidance of unnecessary toxicity. […] Patients with clinical stage I testicular seminoma who undergo orchiectomy are preferably managed with active surveillance; other options include adjuvant chemotherapy or adjuvant radiation therapy. Patients with clinical stage I nonseminomatous germ cell tumor (NSGCT) who undergo orchiectomy are preferably managed with surveillance; other options include adjuvant chemotherapy or retroperitoneal lymph node dissection (RPLND). Active surveillance has not been directly compared with these other treatment strategies in randomized trials. […] The role of surveillance in stage I testicular GCTs (both seminoma and NSGCT) treated with orchiectomy is presented here.

• #27 Surveillance for stage I testicular germ cell tumors following orchiectomy – UpToDate

  https://www.uptodate.com/contents/surveillance-for-stage-i-testicular-germ-cell-tumors-following-orchiectomy

  Surveillance for stage I testicular germ cell tumors following orchiectomy […] Testicular germ cell tumor (GCT) is a highly curable cancer, with five-year survival rates of over 95 percent. For most patients with stage I GCTs who are treated with orchiectomy, surveillance is the preferred approach given low relapse rates, excellent long-term overall survival, and avoidance of unnecessary toxicity. […] Patients with clinical stage I testicular seminoma who undergo orchiectomy are preferably managed with active surveillance; other options include adjuvant chemotherapy or adjuvant radiation therapy. Patients with clinical stage I nonseminomatous germ cell tumor (NSGCT) who undergo orchiectomy are preferably managed with surveillance; other options include adjuvant chemotherapy or retroperitoneal lymph node dissection (RPLND). Active surveillance has not been directly compared with these other treatment strategies in randomized trials. […] The role of surveillance in stage I testicular GCTs (both seminoma and NSGCT) treated with orchiectomy is presented here.

• #28 Germ Cell Tumors – Holland-Frei Cancer Medicine – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK13572/

  Germ cell tumors (GCTs) are rare in children and occur with an incidence of 2.4 cases per million children per year; this number accounts for less than 3% of all pediatric malignancies. This incidence is, however, underestimated, because most tumor registries are biased toward the inclusion of malignant types and tend to exclude most mature teratomas. The distribution of GCTs with age follows a bimodal pattern: peak incidences of GCTs occur during the first 3 years of life and in late adolescence. In general, there is a higher overall incidence of GCTs among girls and young women, although boys and young men are more at risk for malignant GCTs. The only known predisposing factors for GCTs in male pediatric patients are cryptorchidism and gonadal dysgenesis. […] GCTs have an infiltrative growth pattern and can disseminate by lymphogenous and hematogenous routes. The most common sites of hematogenous metastases are the lungs and liver. Serologic markers are very useful for diagnosis, monitoring of response, and prediction of recurrence. Serum -fetoprotein concentrations are usually elevated in tumors with YST components. […] Surveillance is appropriate for 3 to 5 years after surgical treatment, and should include monitoring of serum -fetoprotein concentrations.

• #29 Management of Testicular Germ Cell Tumors – Hematology & Oncology

  https://www.hematologyandoncology.net/archives/april-2023/management-of-testicular-germ-cell-tumors/

  Over the last century, the incidence of testis cancer has been rising substantially, albeit with great regional variation. The rate of increase is slowing significantly in developed nations but not in low- and middle-income countries. Testis cancer mortality has declined dramatically in developed countries owing to improvements in treatment, but remains high in the developing world. The incidence to mortality ratio is 2:1 in parts of Asia and Africa vs 26:1 in Northern Europe. Increases in incidence suggest an environmental cause, but specific environmental factors have not been definitively identified. […] The tumor markers AFP, β-HCG, and LDH are important in staging, risk stratification, diagnosis, and surveillance of GCTs. However, these tumor markers are not 100% sensitive nor 100% specific, as evidenced by the fact that roughly 25% of stage I NSGCTs and 18% of stage I seminomas relapse despite having had normal tumor markers prior to relapse, and a substantial proportion of patients have normal markers when metastatic disease is detected. Given these limitations, researchers are searching for improved biomarkers, with microRNAs as a leading candidate.

• #30 Management of Testicular Germ Cell Tumors – Hematology & Oncology

  https://www.hematologyandoncology.net/archives/april-2023/management-of-testicular-germ-cell-tumors/

  Over the last century, the incidence of testis cancer has been rising substantially, albeit with great regional variation. The rate of increase is slowing significantly in developed nations but not in low- and middle-income countries. Testis cancer mortality has declined dramatically in developed countries owing to improvements in treatment, but remains high in the developing world. The incidence to mortality ratio is 2:1 in parts of Asia and Africa vs 26:1 in Northern Europe. Increases in incidence suggest an environmental cause, but specific environmental factors have not been definitively identified. […] The tumor markers AFP, β-HCG, and LDH are important in staging, risk stratification, diagnosis, and surveillance of GCTs. However, these tumor markers are not 100% sensitive nor 100% specific, as evidenced by the fact that roughly 25% of stage I NSGCTs and 18% of stage I seminomas relapse despite having had normal tumor markers prior to relapse, and a substantial proportion of patients have normal markers when metastatic disease is detected. Given these limitations, researchers are searching for improved biomarkers, with microRNAs as a leading candidate.

• #31 Surveillance for Stage I Testicular Cancer: How Effective?logo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na35882/2014/10/08/surveillance-stage-i-testicular-cancer-how-effective

  Disease-specific survival at 15 years was 99%. […] After undergoing orchiectomy, men with stage I nonseminoma germ cell tumors (NSGCT) can be managed with retroperitoneal lymph node dissection (RPLND), adjuvant chemotherapy (cisplatin, etoposide, and bleomycin), or surveillance. Regardless of how patients are managed, the cure rates of these patients are in the range of 98% to 99%. […] To examine outcomes associated with surveillance, investigators reviewed the records of 1226 men in the Danish National Patient Register who were observed after orchiectomy for stage I NSGCT between 1984 and 2007. […] Early relapses were mainly detected by an increase in tumor markers, and late relapses were detected by CT scans. […] Adherence to the surveillance program was good; only 48 patients (3.9%) dropped out before the final control at 5 years. […] For the bulk of patients with stage I NSGCT, this large, well-documented study with long follow-up provides a substantial level of comfort that patients can be managed safely without the adverse effects of chemotherapy or RPLND.

• #32 Surveillance for Stage I Testicular Cancer: How Effective?logo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na35882/2014/10/08/surveillance-stage-i-testicular-cancer-how-effective

  Disease-specific survival at 15 years was 99%. […] After undergoing orchiectomy, men with stage I nonseminoma germ cell tumors (NSGCT) can be managed with retroperitoneal lymph node dissection (RPLND), adjuvant chemotherapy (cisplatin, etoposide, and bleomycin), or surveillance. Regardless of how patients are managed, the cure rates of these patients are in the range of 98% to 99%. […] To examine outcomes associated with surveillance, investigators reviewed the records of 1226 men in the Danish National Patient Register who were observed after orchiectomy for stage I NSGCT between 1984 and 2007. […] Early relapses were mainly detected by an increase in tumor markers, and late relapses were detected by CT scans. […] Adherence to the surveillance program was good; only 48 patients (3.9%) dropped out before the final control at 5 years. […] For the bulk of patients with stage I NSGCT, this large, well-documented study with long follow-up provides a substantial level of comfort that patients can be managed safely without the adverse effects of chemotherapy or RPLND.

• #33 Surveillance for Stage I Testicular Cancer: How Effective?logo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na35882/2014/10/08/surveillance-stage-i-testicular-cancer-how-effective

  Disease-specific survival at 15 years was 99%. […] After undergoing orchiectomy, men with stage I nonseminoma germ cell tumors (NSGCT) can be managed with retroperitoneal lymph node dissection (RPLND), adjuvant chemotherapy (cisplatin, etoposide, and bleomycin), or surveillance. Regardless of how patients are managed, the cure rates of these patients are in the range of 98% to 99%. […] To examine outcomes associated with surveillance, investigators reviewed the records of 1226 men in the Danish National Patient Register who were observed after orchiectomy for stage I NSGCT between 1984 and 2007. […] Early relapses were mainly detected by an increase in tumor markers, and late relapses were detected by CT scans. […] Adherence to the surveillance program was good; only 48 patients (3.9%) dropped out before the final control at 5 years. […] For the bulk of patients with stage I NSGCT, this large, well-documented study with long follow-up provides a substantial level of comfort that patients can be managed safely without the adverse effects of chemotherapy or RPLND.

• #34 Outcomes of relapsed clinical stage I versus de novo metastatic testicular cancer patients: an analysis of the IGCCCG Update database | British Journal of Cancer

  https://www.nature.com/articles/s41416-023-02443-3

  Active surveillance after orchiectomy is the preferred management in clinical stage I (CSI) germ-cell tumours (GCT) associated with a 15 to 30% relapse rate. […] Around 70% of GCT patients present with CSI disease, of whom 15-30% will experience a relapse if followed on an active surveillance programme. […] The present analysis included a large patient cohort and broad representation from cancer centres worldwide and excluded data obtained from clinical trials. Thus, the results might be close to clinical reality in many countries. It is reassuring that we found no differences in PFS or OS in patients relapsing from initial CSI as compared to de novo metastatic patients with the same IGCCCG prognostic group, demonstrating that active surveillance is safe. However, about 18% of NSem patients and 4% of Sem patients relapsed from initial CSI with intermediate or poor prognosis, which is more than expected from previous reports and exposes those patients to more intensive treatments. Follow-up schedules for active surveillance need to strike the balance of not being unnecessarily tight and not missing out on relapses in time.

• #35 Outcomes of relapsed clinical stage I versus de novo metastatic testicular cancer patients: an analysis of the IGCCCG Update database | British Journal of Cancer

  https://www.nature.com/articles/s41416-023-02443-3

  Active surveillance after orchiectomy is the preferred management in clinical stage I (CSI) germ-cell tumours (GCT) associated with a 15 to 30% relapse rate. […] Around 70% of GCT patients present with CSI disease, of whom 15-30% will experience a relapse if followed on an active surveillance programme. […] The present analysis included a large patient cohort and broad representation from cancer centres worldwide and excluded data obtained from clinical trials. Thus, the results might be close to clinical reality in many countries. It is reassuring that we found no differences in PFS or OS in patients relapsing from initial CSI as compared to de novo metastatic patients with the same IGCCCG prognostic group, demonstrating that active surveillance is safe. However, about 18% of NSem patients and 4% of Sem patients relapsed from initial CSI with intermediate or poor prognosis, which is more than expected from previous reports and exposes those patients to more intensive treatments. Follow-up schedules for active surveillance need to strike the balance of not being unnecessarily tight and not missing out on relapses in time.

• #36 Prediction of relapse in stage I testicular germ cell tumor patients on surveillance: investigation of biomarkers | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-020-07220-6

  Better biomarkers for assessing risk of relapse in stage I testicular germ cell tumor patients are needed, to complement classical histopathological variables. […] Testicular germ cell tumors are among the most common solid neoplasms in young-adult males. Their overall good prognosis puts them on the top of most curable solid cancers, with survival rates above 85-90%. […] For this reason, there is an urgent need for predictive biomarkers to assess the risk of stage I patients, and accurately discriminate those truly benefiting from adjuvant treatment to prevent relapses, from those that can safely be followed using surveillance to avoid early and late side effects of additional treatments on individuals most likely becoming long-term cancer survivors. […] Vascular invasion is the most discriminative biomarker so far, even in multivariable analyses.

• #37 Prediction of relapse in stage I testicular germ cell tumor patients on surveillance: investigation of biomarkers | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-020-07220-6

  Better biomarkers for assessing risk of relapse in stage I testicular germ cell tumor patients are needed, to complement classical histopathological variables. […] Testicular germ cell tumors are among the most common solid neoplasms in young-adult males. Their overall good prognosis puts them on the top of most curable solid cancers, with survival rates above 85-90%. […] For this reason, there is an urgent need for predictive biomarkers to assess the risk of stage I patients, and accurately discriminate those truly benefiting from adjuvant treatment to prevent relapses, from those that can safely be followed using surveillance to avoid early and late side effects of additional treatments on individuals most likely becoming long-term cancer survivors. […] Vascular invasion is the most discriminative biomarker so far, even in multivariable analyses.

• #38 Prediction of relapse in stage I testicular germ cell tumor patients on surveillance: investigation of biomarkers | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-020-07220-6

  Overall, accurate pathological assessment is key since overdiagnosis may result in overtreatment. […] Our work re-confirms the prognostic value of clinicopathological variables regarding disease relapse of stage I testicular germ cell tumor patients. Vascular invasion significantly associated with relapse in the overall cohort and significantly influenced relapse-free survival. […] However, disagreements in scoring vascular invasion exist, more evident between peripheral and centralized centers with expertise on germ cell tumors, and these could result in over- and undertreatment. […] Surveillance strategies are increasingly being employed in the approach to testicular germ cell tumor patients, given the outstanding cure rates of stage I disease with orchiectomy alone. […] Overall, we believe that several protein biomarkers could bring additional value for the prediction of relapse in stage I testicular germ cell tumor patients, but further studies, large, multicentric and prospective, with defined methodology should be pursued before sound conclusions with clinical robustness can be made.

• #39 Prediction of relapse in stage I testicular germ cell tumor patients on surveillance: investigation of biomarkers | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-020-07220-6

  Overall, accurate pathological assessment is key since overdiagnosis may result in overtreatment. […] Our work re-confirms the prognostic value of clinicopathological variables regarding disease relapse of stage I testicular germ cell tumor patients. Vascular invasion significantly associated with relapse in the overall cohort and significantly influenced relapse-free survival. […] However, disagreements in scoring vascular invasion exist, more evident between peripheral and centralized centers with expertise on germ cell tumors, and these could result in over- and undertreatment. […] Surveillance strategies are increasingly being employed in the approach to testicular germ cell tumor patients, given the outstanding cure rates of stage I disease with orchiectomy alone. […] Overall, we believe that several protein biomarkers could bring additional value for the prediction of relapse in stage I testicular germ cell tumor patients, but further studies, large, multicentric and prospective, with defined methodology should be pursued before sound conclusions with clinical robustness can be made.

• #40 Prediction of relapse in stage I testicular germ cell tumor patients on surveillance: investigation of biomarkers | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-020-07220-6

  Overall, accurate pathological assessment is key since overdiagnosis may result in overtreatment. […] Our work re-confirms the prognostic value of clinicopathological variables regarding disease relapse of stage I testicular germ cell tumor patients. Vascular invasion significantly associated with relapse in the overall cohort and significantly influenced relapse-free survival. […] However, disagreements in scoring vascular invasion exist, more evident between peripheral and centralized centers with expertise on germ cell tumors, and these could result in over- and undertreatment. […] Surveillance strategies are increasingly being employed in the approach to testicular germ cell tumor patients, given the outstanding cure rates of stage I disease with orchiectomy alone. […] Overall, we believe that several protein biomarkers could bring additional value for the prediction of relapse in stage I testicular germ cell tumor patients, but further studies, large, multicentric and prospective, with defined methodology should be pursued before sound conclusions with clinical robustness can be made.

• #41 UCSD Germ Cell Tumor Trial → Active Surveillance, Bleomycin, Etoposide, Carboplatin or Cisplatin in Treating Pediatric and Adult Patients With Germ Cell Tumors

  https://clinicaltrials.ucsd.edu/trial/NCT03067181

  This phase III trial studies how well active surveillance help doctors to monitor subjects with low risk germ cell tumors for recurrence after their tumor is removed. […] The trial studies whether carboplatin or cisplatin is the preferred chemotherapy to use in treating metastatic standard risk germ cell tumors. […] To evaluate whether a strategy of complete surgical resection followed by surveillance can maintain an overall survival rate of at least 95.7% at two years for pediatric, adolescent and adult patients with stage I (low risk) malignant germ cell tumors, and at least 95% for patients with ovarian pure immature teratoma. […] To compare the event-free survival of a carboplatin versus (vs.) cisplatin-based regimen in the treatment of pediatric, adolescent and young adult patients with standard risk non-seminomatous germ cell tumors.

• #42 AGCT1531: A Phase 3 Study of Active Surveillance for Low Risk and a Randomized Trial of Carboplatin vs. Cisplatin for Standard Risk Pediatric and Adult Patients With Germ Cell Tumors

  https://www.cincinnatichildrens.org/service/c/clinical-trials/studies/AGCT1531

  AGCT1531: A Phase 3 Study of Active Surveillance for Low Risk and a Randomized Trial of Carboplatin vs. Cisplatin for Standard Risk Pediatric and Adult Patients With Germ Cell Tumors […] This partially randomized phase III trial studies how well active surveillance, bleomycin, carboplatin, etoposide, or cisplatin work in treating pediatric and adult patients with germ cell tumors. Active surveillance may help doctors to monitor subjects with low risk germ cell tumors after their tumor is removed. […] PRIMARY OBJECTIVES: To evaluate whether a strategy of complete surgical resection followed by surveillance can maintain an overall survival rate of at least 95.7% at two years for pediatric, adolescent and adult patients (ages 0- 50 years) with stage I (low risk) malignant germ cell tumors, and at least 98% for patients with ovarian pure immature teratoma.

• #43 AGCT1531: A Phase 3 Study of Active Surveillance for Low Risk and a Randomized Trial of Carboplatin vs. Cisplatin for Standard Risk Pediatric and Adult Patients With Germ Cell Tumors

  https://www.cincinnatichildrens.org/service/c/clinical-trials/studies/AGCT1531

  AGCT1531: A Phase 3 Study of Active Surveillance for Low Risk and a Randomized Trial of Carboplatin vs. Cisplatin for Standard Risk Pediatric and Adult Patients With Germ Cell Tumors […] This partially randomized phase III trial studies how well active surveillance, bleomycin, carboplatin, etoposide, or cisplatin work in treating pediatric and adult patients with germ cell tumors. Active surveillance may help doctors to monitor subjects with low risk germ cell tumors after their tumor is removed. […] PRIMARY OBJECTIVES: To evaluate whether a strategy of complete surgical resection followed by surveillance can maintain an overall survival rate of at least 95.7% at two years for pediatric, adolescent and adult patients (ages 0- 50 years) with stage I (low risk) malignant germ cell tumors, and at least 98% for patients with ovarian pure immature teratoma.

• #44 AGCT1531: A Phase 3 Study of Active Surveillance for Low Risk and a Randomized Trial of Carboplatin vs. Cisplatin for Standard Risk Pediatric and Adult Patients With Germ Cell Tumors

  https://www.cincinnatichildrens.org/service/c/clinical-trials/studies/AGCT1531

  To compare the event-free survival of a carboplatin versus (vs.) cisplatin-based regimen in the treatment of pediatric, adolescent and young adult patients with standard risk germ cell tumors. […] To compare the EFS of a carboplatin-based regimen (BEC) vs. a cisplatin-based regimen (BEP) in adolescents and young adults (ages 11 – 25 years) with standard risk GCT.

• #45 UCSF Germ Cell Tumor Trial → Active Surveillance, Bleomycin, Etoposide, Carboplatin or Cisplatin in Treating Pediatric and Adult Patients With Germ Cell Tumors

  https://clinicaltrials.ucsf.edu/trial/NCT03067181

  Patients with low-risk stage I grade 2, 3 ovarian immature teratoma or stage I non-seminoma malignant germ cell tumors (MGCT)s undergo observation and can transfer to standard risk arm at time of recurrence if eligibility criteria are met. […] After completion of study treatment, patients are followed up every 2 months for 12 months, every 3-6 months to 24 months, every 6 months for years 3-5, and then annually for up to 10 years.

• #46 Testicular Cancer (Germ Cell Tumors) | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/testicular-germ-cell-tumors

  Testicular cancer is not a common disease. Each year, only about 9,000 people in the United States get testicular cancer. Many of them between the ages of 15 and 35. Most cases of testicular cancer can be cured. […] There have been new advances in the diagnosis and treatment of this cancer. Most people can survive the disease, especially if the tumor is found at an early stage. […] We are also testing new ways to find cancer and monitor it (surveillance) with our micro RNA (miRNA) research program. miRNAs are genetic material made by tumors that can be found in the blood. We are using new laboratory methods to isolate (separate) certain miRNAs for use as tumor markers. These markers can help us diagnose and treat testicular cancer. […] Most people treated for testicular cancer at MSK are eligible to join this diagnostic trial. A diagnostic trial is a clinical trial studying a new way to diagnose and treat cancer.

• #47 Human Germ Cell Tumors are Developmental Cancers: Impact of Epigenetics on Pathobiology and Clinic

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6359418/

  Similar data is replicated by the Surveillance, Epidemiology, and End Results Program (SEER) database; despite representing only 0.5% of all new cancer cases in the United States, incidence rates have been rising 0.8% per year over the last 10 years and the number of new cases of testicular cancer was 5.7 per 100,000 males per year according to 2011-2015 registries. […] Importantly, variation in testicular cancer incidence rates worldwide is remarkable (29-fold variation, being higher in Europe, Australia and the United States), and mortality-to-incidence ratio is reported to be higher in underdeveloped regions of the globe, probably due to less access to proper healthcare facilities, diagnostic tools, and multimodal treatments. […] All in all, there are a number of reasons to remain focused on TGCTs: besides the rising incidence in part explained by Western lifestyle, about 15-20% of patients with disseminated disease experience disease recurrence (with late relapses displaying poor prognosis); in spite of exquisite sensitivity to cytotoxic agents, resistance to cisplatin treatment eventually emerges in some cases, by still elusive mechanisms; and also the diagnosis of cancer in such young patients (with long life-expectancy) who undergo chemo and radiotherapy raises concerns over quality of life, fertility and enduring treatment-related side effects, such as the emergence of second tumors and cardiovascular disease, and merit proper action to prevent them.

• #48 Human Germ Cell Tumors are Developmental Cancers: Impact of Epigenetics on Pathobiology and Clinic

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6359418/

  Similar data is replicated by the Surveillance, Epidemiology, and End Results Program (SEER) database; despite representing only 0.5% of all new cancer cases in the United States, incidence rates have been rising 0.8% per year over the last 10 years and the number of new cases of testicular cancer was 5.7 per 100,000 males per year according to 2011-2015 registries. […] Importantly, variation in testicular cancer incidence rates worldwide is remarkable (29-fold variation, being higher in Europe, Australia and the United States), and mortality-to-incidence ratio is reported to be higher in underdeveloped regions of the globe, probably due to less access to proper healthcare facilities, diagnostic tools, and multimodal treatments. […] All in all, there are a number of reasons to remain focused on TGCTs: besides the rising incidence in part explained by Western lifestyle, about 15-20% of patients with disseminated disease experience disease recurrence (with late relapses displaying poor prognosis); in spite of exquisite sensitivity to cytotoxic agents, resistance to cisplatin treatment eventually emerges in some cases, by still elusive mechanisms; and also the diagnosis of cancer in such young patients (with long life-expectancy) who undergo chemo and radiotherapy raises concerns over quality of life, fertility and enduring treatment-related side effects, such as the emergence of second tumors and cardiovascular disease, and merit proper action to prevent them.

• #49 Comparison on epidemiology, tumor location, histology, and prognosis of intracranial germ cell tumors between Mayo Clinic and Japanese consortium cohorts in: Journal of Neurosurgery Volume 134 Issue 2 (2020) Journals

  https://thejns.org/view/journals/j-neurosurg/134/2/article-p446.xml

  Central nervous system (CNS) germ cell tumors (GCTs) are rare malignant neoplasms that arise predominantly in adolescents and young adults. CNS GCTs demonstrate characteristic trends in national associations, with implications for both tumor incidence and genetics. […] Although the incidence of CNS GCTs is markedly higher in East Asia than Western countries, direct comparative analyses between these CNS GCT populations are limited. […] In Japan, to facilitate the genomic analyses of CNS GCTs, the Intracranial Germ Cell Tumor Genome Analysis Consortium was established in 2011, and more than 200 cases of GCTs are available for both tumor tissue and clinical data, which is organized by the National Cancer Center (NCC) Japan. At the Mayo Clinic, there have been 98 cases of intracranial GCTs treated by the Department of Neurologic Surgery since 1988. In this paper, the authors compared the epidemiology, clinical presentation including location and histology, and prognosis between cases treated in the US and Japan.

• #50 Comparison on epidemiology, tumor location, histology, and prognosis of intracranial germ cell tumors between Mayo Clinic and Japanese consortium cohorts in: Journal of Neurosurgery Volume 134 Issue 2 (2020) Journals

  https://thejns.org/view/journals/j-neurosurg/134/2/article-p446.xml

  There was no significant difference in age and sex distributions between the databases. However, there was a significant difference in the tumor locations; specifically, the frequency of basal ganglia was higher in the NCC database compared with the Mayo Clinic (8.4% vs 0%, p = 0.008), and bifocal location (neurohypophysis and pineal gland) was higher at the Mayo Clinic than at the NCC (18.8% vs 5.8%, p = 0.002). […] There was no difference in progression-free survival (PFS) and overall survival (OS) of germinoma cases and OS of nongerminomatous GCT (NGGCT) cases treated with chemotherapy and radiation therapy covering whole ventricles. However, PFS of NGGCTs differed significantly, and was better in the NCC cohorts (p = 0.04). […] There appears to be a differential distribution of GCTs by neuroanatomical location between major geographic and national groups. Further study is warranted to better characterize any underlying genomic, epigenetic, or environmental factors that may be driving the phenotypic differences.

• #51 Comparison on epidemiology, tumor location, histology, and prognosis of intracranial germ cell tumors between Mayo Clinic and Japanese consortium cohorts in: Journal of Neurosurgery Volume 134 Issue 2 (2020) Journals

  https://thejns.org/view/journals/j-neurosurg/134/2/article-p446.xml

  There was no significant difference in age and sex distributions between the databases. However, there was a significant difference in the tumor locations; specifically, the frequency of basal ganglia was higher in the NCC database compared with the Mayo Clinic (8.4% vs 0%, p = 0.008), and bifocal location (neurohypophysis and pineal gland) was higher at the Mayo Clinic than at the NCC (18.8% vs 5.8%, p = 0.002). […] There was no difference in progression-free survival (PFS) and overall survival (OS) of germinoma cases and OS of nongerminomatous GCT (NGGCT) cases treated with chemotherapy and radiation therapy covering whole ventricles. However, PFS of NGGCTs differed significantly, and was better in the NCC cohorts (p = 0.04). […] There appears to be a differential distribution of GCTs by neuroanatomical location between major geographic and national groups. Further study is warranted to better characterize any underlying genomic, epigenetic, or environmental factors that may be driving the phenotypic differences.

• #52 Testicular Cancer: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/279007-overview

  Epidemiologic observations have suggested that environmental factors are instrumental in determining risk for testicular cancers. However, epidemiologic evidence does not consistently support any specific risk factor. […] The incidence of testicular cancer is fivefold higher in whites than in African Americans; however, African Americans tend to present with higher-grade disease and have much worse prognosis than whites. […] A review of SEER data found that in Hispanic Whites ages 15 to 39 years, the annual incidence of testicular germ cell tumors increased 58% between 1992 and 2010, from 7.18 to 11.34 cases per 100,000. By comparison, during that period the incidence in non-Hispanic White young adults increased 7%, from 12.41 to 13.22 cases per 100,000. […] Testicular cancer can occur at any age but is most common between the ages of 15 and 35 years; about 50% of cases occur in men 20-34 years old. There is also a secondary peak in incidence after age 60.

• #53 Extragonadal Germ Cell Tumors: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/278174-overview

  Extragonadal germ cell tumors (EGGCTs) represent approximately 5% of all germ cell tumor (GCTs), with an incidence around 1.9 3.4 per million population. […] In Norway, a study by Dueland et al estimated the incidence of extragonadal germ cell tumor at 0.5 per 100,000 population per year. […] In adults, only benign extragonadal germ cell tumors (teratomas) occur at equal frequency in both sexes; more than 90% of malignant extragonadal germ cell tumors occur in males. […] Extragonadal germinal cell syndromes are rare tumors that predominantly affect young males. Pediatric germ cell tumors (GCTs) account for approximately 3.5% of cancers in children under the age of 15 years and increase in frequency to 13.9% among 15- to 19-year-olds. […] Racial disparities in mortality rates among males with GCTs have been reported. In a review of Surveillance, Epidemiology, and End Results (SEER) Program data, mortality rates were significantly higher in Hispanic and Asian/Pacific Island males than in White males.

• #54

  http://waocp.com/journal/index.php/apjcc/article/view/346

  The Western nations reported earlier stage at diagnosis while most of the Indian studies have reported advanced stage at presentation. […] In this study we found that the largest median tumor size was 6 cm (3.2-12) for seminoma and 6 cm (4-12.3) nonseminoma. […] The overall CR, PR and SD were 15.8%, 63.2% and 0% respectively and assessment could not be done in 21.1%. […] Classifying the cases on the basis of risk factor we found that good risk, intermediate risk and high risk cases were 65.8%, 13.2% and 21.1% respectively. […] Most of the cases presented with advanced stage and majority of them have undergone high inguinal orchidectomy which is the standard surgical procedure for testicular germ cell tumor. […] Overall survival in our study was not matching to the data of western studies the reason for this may be advanced disease at presentation, bulky retroperitoneal nodal disease, treatment abandonment, failure to maintain dose intensity and lost to proper follow up.

• #55

  http://waocp.com/journal/index.php/apjcc/article/view/346

  Malignant testicular neoplasm constitutes about 1% of all cancers in male, but malignant germ cell tumors are most common tumors in adolescents and young adult males. […] In this study we report our experience of testicular germ cell tumors presenting at All India Institute of Medical Sciences, Patna, a tertiary referral centre, with respect to epidemiology, histopathology, management and outcome. […] The study focused on epidemiology and survival outcomes. […] The most common affected age group was 31 to 40 years. […] The high nodal burden disease at presentation was associated with partial response to standard chemotherapy. […] It seems that there is the need of alternative chemotherapy regimen especially in nonseminomatous germ cell tumors. […] Patients presenting with disease confined to locoregional lymph nodes or local disease showed good prognosis.

• #56

  http://waocp.com/journal/index.php/apjcc/article/view/346

  The Western nations reported earlier stage at diagnosis while most of the Indian studies have reported advanced stage at presentation. […] In this study we found that the largest median tumor size was 6 cm (3.2-12) for seminoma and 6 cm (4-12.3) nonseminoma. […] The overall CR, PR and SD were 15.8%, 63.2% and 0% respectively and assessment could not be done in 21.1%. […] Classifying the cases on the basis of risk factor we found that good risk, intermediate risk and high risk cases were 65.8%, 13.2% and 21.1% respectively. […] Most of the cases presented with advanced stage and majority of them have undergone high inguinal orchidectomy which is the standard surgical procedure for testicular germ cell tumor. […] Overall survival in our study was not matching to the data of western studies the reason for this may be advanced disease at presentation, bulky retroperitoneal nodal disease, treatment abandonment, failure to maintain dose intensity and lost to proper follow up.

• #57

  http://waocp.com/journal/index.php/apjcc/article/view/346

  The Western nations reported earlier stage at diagnosis while most of the Indian studies have reported advanced stage at presentation. […] In this study we found that the largest median tumor size was 6 cm (3.2-12) for seminoma and 6 cm (4-12.3) nonseminoma. […] The overall CR, PR and SD were 15.8%, 63.2% and 0% respectively and assessment could not be done in 21.1%. […] Classifying the cases on the basis of risk factor we found that good risk, intermediate risk and high risk cases were 65.8%, 13.2% and 21.1% respectively. […] Most of the cases presented with advanced stage and majority of them have undergone high inguinal orchidectomy which is the standard surgical procedure for testicular germ cell tumor. […] Overall survival in our study was not matching to the data of western studies the reason for this may be advanced disease at presentation, bulky retroperitoneal nodal disease, treatment abandonment, failure to maintain dose intensity and lost to proper follow up.

• #58

  https://journals.lww.com/indianjcancer/fulltext/2016/53020/epidemiology_of_male_seminomatous_and.27.aspx

  Unlike the developed countries, there is a lack of good epidemiologic data for testicular germ cell tumors (GCTs) in India with majority presenting in advanced stage. […] GCTs in India present with high nodal and high-risk diseases wherein the standard first-line CT may not be adequate as curative therapy; however, significant chemotoxicity is also a hindrance. […] With the exceptions of few small series, there is a lack of recent data from India on GCT epidemiology, the response rates, and toxicity profile of first-line chemotherapy. […] In our study, 58% of NSGCTs belonged to poor- or intermediate-risk group, with 46% of NSGCT having N3 disease and 64% having metastatic disease at presentation. […] This figure is substantially higher than that reported from developed countries where the combined poor- and intermediate-risk NSGCTs account for 20-30% cases and that of N3 disease account for only 10-15%.

• #59

  https://journals.lww.com/indianjcancer/fulltext/2016/53020/epidemiology_of_male_seminomatous_and.27.aspx

  Similarly, 28% of SGCTs in our study had N3 nodal disease, a number substantially higher than that reported from the west where it is fewer than 5%. […] After first-line chemotherapy, only 5% of NSGCTs had radiologic CR as per RECIST. […] These results were disappointingly low. […] The major challenge in treating NSGCT at our center has been the presence of bulky nodal disease reflected in the fact that none of the cases with N3 nodal NSGCT achieved a CR. […] In SGCTs, which had predominantly good-risk disease, CR rates were only 17%. […] This again is much lower than previous reports of good-risk disease of SGCTs where the CR rates with first-line chemotherapy were in the range of 88-97%. […] There is an unmet need of a better chemotherapy regimen than the standard BEP for GCTs in first-line setting with high nodal disease burden.

• #60 Management of Testicular Germ Cell Tumors – Hematology & Oncology

  https://www.hematologyandoncology.net/archives/april-2023/management-of-testicular-germ-cell-tumors/

  Over the last century, the incidence of testis cancer has been rising substantially, albeit with great regional variation. The rate of increase is slowing significantly in developed nations but not in low- and middle-income countries. Testis cancer mortality has declined dramatically in developed countries owing to improvements in treatment, but remains high in the developing world. The incidence to mortality ratio is 2:1 in parts of Asia and Africa vs 26:1 in Northern Europe. Increases in incidence suggest an environmental cause, but specific environmental factors have not been definitively identified. […] The tumor markers AFP, β-HCG, and LDH are important in staging, risk stratification, diagnosis, and surveillance of GCTs. However, these tumor markers are not 100% sensitive nor 100% specific, as evidenced by the fact that roughly 25% of stage I NSGCTs and 18% of stage I seminomas relapse despite having had normal tumor markers prior to relapse, and a substantial proportion of patients have normal markers when metastatic disease is detected. Given these limitations, researchers are searching for improved biomarkers, with microRNAs as a leading candidate.

• #61 Management of Testicular Germ Cell Tumors – Hematology & Oncology

  https://www.hematologyandoncology.net/archives/april-2023/management-of-testicular-germ-cell-tumors/

  Over the last century, the incidence of testis cancer has been rising substantially, albeit with great regional variation. The rate of increase is slowing significantly in developed nations but not in low- and middle-income countries. Testis cancer mortality has declined dramatically in developed countries owing to improvements in treatment, but remains high in the developing world. The incidence to mortality ratio is 2:1 in parts of Asia and Africa vs 26:1 in Northern Europe. Increases in incidence suggest an environmental cause, but specific environmental factors have not been definitively identified. […] The tumor markers AFP, β-HCG, and LDH are important in staging, risk stratification, diagnosis, and surveillance of GCTs. However, these tumor markers are not 100% sensitive nor 100% specific, as evidenced by the fact that roughly 25% of stage I NSGCTs and 18% of stage I seminomas relapse despite having had normal tumor markers prior to relapse, and a substantial proportion of patients have normal markers when metastatic disease is detected. Given these limitations, researchers are searching for improved biomarkers, with microRNAs as a leading candidate.

• #62 Systemic therapy for primary and extragonadal germ cell tumors: prognosis and nuances of treatment – Siddiqui – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/29436/html

  Testicular germ cell tumors are the most common solid tumors in young men between the ages of 20 and 34, with an estimated 9,310 cases diagnosed in the United States in 2018, with approximately 400 deaths. […] In general, testicular germ cell tumors carry an excellent prognosis, with a 5-year survival rate of approximately 95%. […] An increasing incidence of testicular cancers has been observed, for uncertain reasons. […] Testicular germ cell tumors account for the vast majority of malignant tumors arising in the testes; these tumors also occasionally arise in extragonadal sites, such as the retroperitoneum and anterior mediastinum. […] Risk factors for testicular cancer include cryptorchidism, family history, and prior history of testicular cancer. […] A well-established standard of care exists for the majority of testicular germ cell tumors, leading to a high overall survival rate.

• #63 Systemic therapy for primary and extragonadal germ cell tumors: prognosis and nuances of treatment – Siddiqui – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/29436/html

  Testicular germ cell tumors are the most common solid tumors in young men between the ages of 20 and 34, with an estimated 9,310 cases diagnosed in the United States in 2018, with approximately 400 deaths. […] In general, testicular germ cell tumors carry an excellent prognosis, with a 5-year survival rate of approximately 95%. […] An increasing incidence of testicular cancers has been observed, for uncertain reasons. […] Testicular germ cell tumors account for the vast majority of malignant tumors arising in the testes; these tumors also occasionally arise in extragonadal sites, such as the retroperitoneum and anterior mediastinum. […] Risk factors for testicular cancer include cryptorchidism, family history, and prior history of testicular cancer. […] A well-established standard of care exists for the majority of testicular germ cell tumors, leading to a high overall survival rate.

• #64 Testicular Cancer: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/279007-overview

  Epidemiologic observations have suggested that environmental factors are instrumental in determining risk for testicular cancers. However, epidemiologic evidence does not consistently support any specific risk factor. […] The incidence of testicular cancer is fivefold higher in whites than in African Americans; however, African Americans tend to present with higher-grade disease and have much worse prognosis than whites. […] A review of SEER data found that in Hispanic Whites ages 15 to 39 years, the annual incidence of testicular germ cell tumors increased 58% between 1992 and 2010, from 7.18 to 11.34 cases per 100,000. By comparison, during that period the incidence in non-Hispanic White young adults increased 7%, from 12.41 to 13.22 cases per 100,000. […] Testicular cancer can occur at any age but is most common between the ages of 15 and 35 years; about 50% of cases occur in men 20-34 years old. There is also a secondary peak in incidence after age 60.

• #65 Germ Cell Tumor Epidemiology Study (GaMETES) | Medical School

  https://med.umn.edu/pediatrics/divisions/epidemiology/research/gametes

  The GaMETES (Germ Cell Tumor Epidemiology Study) was designed to try to find out more about risk factors associated with germ cell tumors in children. […] This is an epidemiologic study, which means that the researchers are gathering information from a lot of families in order to find patterns between potential risk factors they have been exposed to and germ cell tumors. […] It is known that some environmental factors, such as toxic chemicals, can cause disease. […] There are some genetic factors in people which can make it more likely for themselves or their children to develop tumors. […] In this study, both environmental and genetic risk factors are being looked at. […] The DNA from cheek cells may help us discover what genes might be involved in the development of germ cell tumors. […] Only by asking questions such as these can we learn whether any of these factors are important in the development of germ cell tumors.

• #66 Germ Cell Tumor Epidemiology Study (GaMETES) | Medical School

  https://med.umn.edu/pediatrics/divisions/epidemiology/research/gametes

  The GaMETES (Germ Cell Tumor Epidemiology Study) was designed to try to find out more about risk factors associated with germ cell tumors in children. […] This is an epidemiologic study, which means that the researchers are gathering information from a lot of families in order to find patterns between potential risk factors they have been exposed to and germ cell tumors. […] It is known that some environmental factors, such as toxic chemicals, can cause disease. […] There are some genetic factors in people which can make it more likely for themselves or their children to develop tumors. […] In this study, both environmental and genetic risk factors are being looked at. […] The DNA from cheek cells may help us discover what genes might be involved in the development of germ cell tumors. […] Only by asking questions such as these can we learn whether any of these factors are important in the development of germ cell tumors.

• #67 Outcomes of relapsed clinical stage I versus de novo metastatic testicular cancer patients: an analysis of the IGCCCG Update database | British Journal of Cancer

  https://www.nature.com/articles/s41416-023-02443-3

  Active surveillance after orchiectomy is the preferred management in clinical stage I (CSI) germ-cell tumours (GCT) associated with a 15 to 30% relapse rate. […] Around 70% of GCT patients present with CSI disease, of whom 15-30% will experience a relapse if followed on an active surveillance programme. […] The present analysis included a large patient cohort and broad representation from cancer centres worldwide and excluded data obtained from clinical trials. Thus, the results might be close to clinical reality in many countries. It is reassuring that we found no differences in PFS or OS in patients relapsing from initial CSI as compared to de novo metastatic patients with the same IGCCCG prognostic group, demonstrating that active surveillance is safe. However, about 18% of NSem patients and 4% of Sem patients relapsed from initial CSI with intermediate or poor prognosis, which is more than expected from previous reports and exposes those patients to more intensive treatments. Follow-up schedules for active surveillance need to strike the balance of not being unnecessarily tight and not missing out on relapses in time.

• #68 CASE REPORT Late Relapse in Germ Cell Testicular Cancer – American Urological Association

  https://auanews.net/issues/articles/2023/march-2023/case-report-late-relapse-in-germ-cell-testicular-cancer

  Germ cell tumors are the most common cause of cancer in men between the ages of 15 and 35. They are one of the most curable solid tumors, with a survival rate greater than 80%. However, approximately 10% of all patients will experience relapse of the disease during follow-up, the majority presenting in the first 2 years of follow-up and only 1% to 6% beyond 2 years. The approximate incidence according to the histology of the tumor is 3.2% in nonseminomatous tumors and 1.4% in seminoma. This reinforces the importance of long-term follow-up of this pathology. […] These cases emphasize the importance of lifelong surveillance of patients with germ cell tumors, even patients with extremely low risk for late relapse, including those with clinical stage I disease. […] Screening is usually carried out during routine follow-up examinations, either by elevated serum markers such as AFP or human chorionic gonadotropin, radiographic findings, or clinical symptoms such as low back pain or a palpable abdominal mass. It should be noted that early detection will have an impact on prognosis, since symptoms in the initial presentation have been associated with lower cancer-specific survival and overall survival.

• #69 CASE REPORT Late Relapse in Germ Cell Testicular Cancer – American Urological Association

  https://auanews.net/issues/articles/2023/march-2023/case-report-late-relapse-in-germ-cell-testicular-cancer

  Germ cell tumors are the most common cause of cancer in men between the ages of 15 and 35. They are one of the most curable solid tumors, with a survival rate greater than 80%. However, approximately 10% of all patients will experience relapse of the disease during follow-up, the majority presenting in the first 2 years of follow-up and only 1% to 6% beyond 2 years. The approximate incidence according to the histology of the tumor is 3.2% in nonseminomatous tumors and 1.4% in seminoma. This reinforces the importance of long-term follow-up of this pathology. […] These cases emphasize the importance of lifelong surveillance of patients with germ cell tumors, even patients with extremely low risk for late relapse, including those with clinical stage I disease. […] Screening is usually carried out during routine follow-up examinations, either by elevated serum markers such as AFP or human chorionic gonadotropin, radiographic findings, or clinical symptoms such as low back pain or a palpable abdominal mass. It should be noted that early detection will have an impact on prognosis, since symptoms in the initial presentation have been associated with lower cancer-specific survival and overall survival.

• #70 CASE REPORT Late Relapse in Germ Cell Testicular Cancer – American Urological Association

  https://auanews.net/issues/articles/2023/march-2023/case-report-late-relapse-in-germ-cell-testicular-cancer

  Given the high rate of chemoresistance in late relapsed tumors, the cornerstone of treatment is complete surgical excision, although salvage chemotherapy regimens have been described, such as platinum, ifosfamide, paclitaxel, etoposide, and epirubicin, although with low complete response rates, at 20.7% for late response and 42.1% for early relapse. Therefore, the aim of follow-up beyond 5 years shifts to the detection of late side effects of treatment. […] In view of these data, it is debatable if regular follow-up of all testicular cancer patients beyond 5 years is a good use of medical resources as well as keeping health professionals alert about the risk of secondary solid neoplasms in this population, emphasizing careful evaluations to ensure a timely diagnosis.

• #71 CASE REPORT Late Relapse in Germ Cell Testicular Cancer – American Urological Association

  https://auanews.net/issues/articles/2023/march-2023/case-report-late-relapse-in-germ-cell-testicular-cancer

  Given the high rate of chemoresistance in late relapsed tumors, the cornerstone of treatment is complete surgical excision, although salvage chemotherapy regimens have been described, such as platinum, ifosfamide, paclitaxel, etoposide, and epirubicin, although with low complete response rates, at 20.7% for late response and 42.1% for early relapse. Therefore, the aim of follow-up beyond 5 years shifts to the detection of late side effects of treatment. […] In view of these data, it is debatable if regular follow-up of all testicular cancer patients beyond 5 years is a good use of medical resources as well as keeping health professionals alert about the risk of secondary solid neoplasms in this population, emphasizing careful evaluations to ensure a timely diagnosis.

• #72 Testicular Cancer (Germ Cell Tumors) | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/testicular-germ-cell-tumors

  Testicular cancer is not a common disease. Each year, only about 9,000 people in the United States get testicular cancer. Many of them between the ages of 15 and 35. Most cases of testicular cancer can be cured. […] There have been new advances in the diagnosis and treatment of this cancer. Most people can survive the disease, especially if the tumor is found at an early stage. […] We are also testing new ways to find cancer and monitor it (surveillance) with our micro RNA (miRNA) research program. miRNAs are genetic material made by tumors that can be found in the blood. We are using new laboratory methods to isolate (separate) certain miRNAs for use as tumor markers. These markers can help us diagnose and treat testicular cancer. […] Most people treated for testicular cancer at MSK are eligible to join this diagnostic trial. A diagnostic trial is a clinical trial studying a new way to diagnose and treat cancer.

• #73 Testicular Germ Cell Cancer Study – NCI

  https://www.cancer.gov/ccg/research/genome-sequencing/tcga/studied-cancers/testicular-germ-cell-study

  More than 90% of testicular cancer start in the germ cells, which are cells in the testicles and develop into sperm. This type of cancer is known as testicular germ cell cancer. Testicular germ cell cancer is rare, comprising 1-2% of all tumors in males. However, it is the most common cancer in men ages 15 to 35. The incidence of testicular germ cell cancer has been continuously rising in many countries, including Europe and the U.S. In 2013, about 8,000 American men were estimated to be diagnosed with the cancer. Of those, 370 are predicted to die from the disease. Men who are Caucasian, have an undescended testicle, abnormally developed testicles, or a family history of testicular cancer have a greater risk of developing testicular cancer. […] TCGA’s study of testicular germ cell cancer was part of an effort to characterize rare tumor types. […] In a study of 137 testicular germ cell tumors (TGCTs), distinct molecular patterns characterized each of the major histological subtypes of the disease: seminoma, embryonal carcinoma, yolk sac, teratoma. […] Certain molecular features may potentially be used as biomarkers for risk stratification.

• #74 Nomograms to predict the prognosis in malignant ovarian germ cell tumors: a large cohort study | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-022-09324-7

  Malignant ovarian germ cell tumors (MOGCTs) are rare gynecologic neoplasms. The use of nomograms that are based on various clinical indicators to predict the prognosis of MOGCTs are currently lacking. […] Clinical and demographic information of patients with MOGCT recorded between 2004 and 2015 were obtained from the Surveillance, Epidemiology, and End Results database, and Cox regression analysis was performed to screen for important independent prognostic factors. […] A total of 1401 patients with MOGCT were recruited for the study. A nomogram was used to forecast the 1-year, 3-year, and 5-year OS using data pertaining to age, International Federation of Gynecology and Obstetrics (FIGO) staging, histological subtype and grade, and surgical type. […] Malignant ovarian germ cell tumors (MOGCTs) constitute approximately 12% of all ovarian malignant tumors with a predilection to the younger age group, especially during late adolescence and young adulthood.

• #75 Nomograms to predict the prognosis in malignant ovarian germ cell tumors: a large cohort study | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-022-09324-7

  The prognosis is usually good, with a 5-year overall survival (OS) of 95% for stage I tumors and 73% for advanced stage IIIV tumors. […] In the current study, the incidence of tumor and survival data of approximately 34.6% of all cancers in the US were collected from the Linked Surveillance, Epidemiology, and End Results (SEER) database, which is a reliable cancer information source. […] The nomogram can better predict OS of MOGCTs, and has better clinical benefits. […] The nomogram has a better predictive power and clinical utility than the simple FIGO staging system using ROC and DCA analyses. […] In summary, the nomogram of this study demonstrated better prognostic accuracy than that of the FIGO staging system and reliably predicted 1-year, 3-year, and 5-year OS in patients with MOGCTs.

• #76 Systemic therapy for primary and extragonadal germ cell tumors: prognosis and nuances of treatment – Siddiqui – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/29436/html

  For patients with relapsed disease after second-line therapy, treatment options include surgical salvage if feasible, and treatment with either conventional or high dose chemotherapy as above, if either regimen has not yet been administered. […] In summary, while testicular germ cell tumors represent a success story of modern medicine in our ability to cure young patients and offer decades of life, many areas of active investigation remain, particularly in the relapsed and refractory setting.

• #77 Systemic therapy for primary and extragonadal germ cell tumors: prognosis and nuances of treatment – Siddiqui – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/29436/html

  For patients with relapsed disease after second-line therapy, treatment options include surgical salvage if feasible, and treatment with either conventional or high dose chemotherapy as above, if either regimen has not yet been administered. […] In summary, while testicular germ cell tumors represent a success story of modern medicine in our ability to cure young patients and offer decades of life, many areas of active investigation remain, particularly in the relapsed and refractory setting.

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