Table 3 - uploaded by Walter Albrecht
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Source publication
Context:
This is an update of the previous European Association of Urology testis cancer guidelines published in 2011, which included major changes in the diagnosis and treatment of germ cell tumours.
Objective:
To summarise latest developments in the treatment of this rare disease. Recommendations have been agreed within a multidisciplinary wor...
Context in source publication
Context 1
... (US) of both testis remains the cornerstone of primary imaging in patients with testicular tumours followed by computed tomography (CT) of the abdomen and chest as subsequent staging tools (Table 1). Correct interpretation of tumour markers before and after orchiectomy in conjunction with CT findings allows correct patient classification according to TNM and Union for International Cancer Control staging (Tables 2 and 3) [9]. Patients with metastatic disease should be classified according to the International Germ Cell Cancer Collaborative Group (IGCCCG) [10] to tailor further treatment (Table 4). ...
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Context:
Renal transplantation is the gold standard renal replacement therapy in end-stage renal disease owing to its superior survival and quality of life compared with dialysis. When the potential recipient has a history of cancer, the waiting period before radiotherapy is usually based on the Cincinnati Registry.
Objective:
To systematically...
Citations
... Germ cell tumors (GCTs) are relatively rare despite being the most common solid tumor in men between the ages of 15 and 39 years [1]. GCTs are generally highly curable due to chemosensitivity, which has resulted in a five-year survival rate of more than 95% [2]. ...
... Despite GCTs constituting a small percentage of cancers in men, they are the most common solid tumor malignancy in men aged 15-39 years [1]. GCTs are further divided into seminomatous germ cell tumors (SGCT) and nonseminomatous germ cell tumors (NSGCTs). ...
... In terms of treatment considerations for these patients, the standard of care for poor-risk NSGCTs involves four cycles of bleomycin, etoposide, and cisplatin combination (BEP). An alternative regimen of ifosfamide, etoposide, and cisplatin (VIP) is used when bleomycin is contraindicated, as was the case with our patient due to their innumerable pulmonary metastases [1]. Massard et al. demonstrated that adopting a reduced induction chemotherapy approach with etoposide and cisplatin (EP) lowered the risk of ARDS; however, it also resulted in a comparatively lower overall rate of long-term survival in contrast to the full regimen induction [8]. ...
... Furthermore, although we evaluated a high number of CT scans (n = 7098) from the same subspecialty (oncologic imaging), we cannot confidently extend our conclusions to other subspecialties, but we may hopefully encourage similar evaluations in other subspecialties. Last but not least, we did not evaluate the effects of the reduction of radiation dose [38] and we did not consider the effects of the choice of a different imaging technique, such as magnetic resonance [39], because it was beyond the scope of our objectives and deserves dedicated prospective trials. ...
Purposes
The primary objective of this retrospective study was to assess whether the CT dose delivered to oncologic patients was different in a subspecialty radiology department, compared to a general radiology department. The secondary explorative objective was to assess whether the objective image quality of CT examinations was different in the two settings.
Materials and methods
Chest and abdomen CT scans performed for oncologic indications were selected from a general radiology department and a subspecialty radiology department. By using a radiation dose management platform, we extracted and compared CT dose index (CTDI vol ) and dose length product (DLP) both for each phase and for the entire CT exams. For objective image quality evaluation, we calculated the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR) at the level of the liver and of the aorta. A P-value < 0.05 was considered significant.
Results
A total of 7098 CT examinations were included. CTDI vol was evaluated in 12,804 phases; DLP in 10,713 phases and in 6714 examinations. The CTDI vol and DLP overall were significantly lower in the subspecialty radiology department compared to the general radiology department CTDI median (IQR) 5.19 (3.91–7.00) and 5.51 (4.17–7.72), DLP median and IQR of 490.0 (342.4–710.6) and 503.4 (359.9–728.8), p < 0.001 and p = 0.01, respectively. The objective image quality showed no significant difference in the general and subspecialty radiology departments, with median and IQR of 4.03 (2.82–5.51) and 3.84 (3.09–4.94) for SNR Liv ( p = 0.58); 4.81 (2.70–7.62) and 4.34 (3.05–6.25) for SNR Ao ( p = 0.30); 0.83 (0.20–1.89) and 1.00 (0.35–1.57) for CNR Liv ( p = 0.99); 2.23 (0.09–3.83) and 1.01 (0.15–2.84) for CNR Ao ( p = 0.24) with SNR Liv ( p = 0.58), SNR Ao ( p = 0.30), CNR Liv ( p = 0.99) and CNR Ao ( p = 0.24).
Conclusion
In a subspecialty radiology department, CT protocols are optimized compared to a general radiology department leading to lower doses to oncologic patients without significant objective image quality degradation.
... Ultrasonography (US) is often used to confirm the presence of tumors in patients with testicular lesions (7). However, US has limited ability to distinguish benign and malignant testicular lesions effectively or to predict tumor size accurately (8). ...
Objective
Accurate identification of testicular tumors through better lesion characterization can optimize the radical surgical procedures. Here, we compared the performance of different machine learning approaches for discriminating benign testicular lesions from malignant ones, using a radiomics score derived from magnetic resonance imaging (MRI).
Methods
One hundred fifteen lesions from 108 patients who underwent MRI between February 2014 and July 2022 were enrolled in this study. Based on regions-of-interest, radiomics features extraction can be realized through PyRadiomics. For measuring feature reproducibility, we considered both intraclass and interclass correlation coefficients. We calculated the correlation between each feature and the predicted target, removing redundant features. In our radiomics-based analysis, we trained classifiers on 70% of the lesions and compared different models, including linear discrimination, gradient boosting, and decision trees. We applied each classification algorithm to the training set using different random seeds, repeating this process 10 times and recording performance. The highest-performing model was then tested on the remaining 30% of the lesions. We used widely accepted metrics, such as the area under the curve (AUC), to evaluate model performance.
Results
We acquired 1,781 radiomic features from the T2-weighted maps of each lesion. Subsequently, we constructed classification models using the top 10 most significant features. The 10 machine-learning algorithms we utilized were capable of diagnosing testicular lesions. Of these, the XGBoost classification emerged as the most superior, achieving the highest AUC value of 0.905 (95% confidence interval: 0.886–0.925) on the testing set and outstripping the other models that typically scored AUC values between 0.697–0.898.
Conclusion
Preoperative MRI radiomics offers potential for distinguishing between benign and malignant testicular lesions. An ensemble model like the boosting algorithm embodied by XGBoost may outperform other models.
... Testicular cancer (TC) represents approximately 1% of male neoplasms. 1 However, it represents the most common type of cancer in the male demographic aged 15-35 years, contributing to approximately 10%-14% of cancer cases in this age group. 1,2 It is estimated by the American Cancer Society that in 2022, 9910 men will develop TC, and 460 men will die from this disease. ...
... 1 However, it represents the most common type of cancer in the male demographic aged 15-35 years, contributing to approximately 10%-14% of cancer cases in this age group. 1,2 It is estimated by the American Cancer Society that in 2022, 9910 men will develop TC, and 460 men will die from this disease. 3 Most TCs are testicular germ cell tumors (TGCTs) originating from the germinal epithelium of the seminiferous tubules. ...
... Orchiectomy may be postponed until clinical stabilization has been attained. 1 It is very important to perform the histological characterization of GCNIS-related TGCTs with a non-invasive method in these cases. ...
Objective: The aim was to examine the efficacy of multiparametric magnetic resonance imaging (mp-MRI) in the histological differentiation of germ cell neoplasia
in situ (GCNIS)-related testicular germ cell tumors (TGCTs).
Methods: We retrospectively included 58 patients with histologically proven GCNIS-related TGCTs, who underwent mp-MRI between November 2019 and June 2022. The signal characteristics of the tumors on T2-weighted imaging were recorded. The mean apparent diffusion coefficient (ADC) values were calculated. Time signal intensity curves were generated, and semiquantitative parameters were calculated. The presence of a septal enhancement pattern within the tumor was noted. Receiver operating characteristic curve analysis was performed to assess the diagnostic performance of the parameters.
Results: Histopathological examination revealed that 24 of the cases were seminomas, and 10 were non-seminomatous GCT (NSGCTs). The incidence of
hypointense signals was notably higher for seminomas (P < .001). The mean ADC values of the seminomas were lower than NSGCTs (0.645 ± 0.11 and 0.879 ±
0.061, respectively, P < .001). The optimal ADC cutoff value was 0.779 × 10−3 mm2/s. No differences were observed between the 2 groups for semiquantitative
parameters (P = .16-.83). However, the septal enhancement pattern was more frequent in seminomas (P = .002).
Conclusion: Values of ADC measured in mp-MRI can be used as a reliable preoperative method in the histological differentiation of GCNIS-related TGCTs.
Also, the septal enhancement pattern can be helpful in distinguishing between seminoma and NSGCT.
Keywords: Germ cell neoplasia in situ-related testicular germ cell tumors, magnetic resonance imaging, apparent diffusion coefficient, dynamic contrastenhanced
imaging, differential diagnosis
... Although the common tumour markers AFP, beta-HCG and LDH are widely used, they lack specificity and are present in approximately 60% of cases of testicular cancer (12,14). Furthermore, conditions such as liver disease or genetic factors can cause these markers to become falsely elevated (15). Without reliable biomarkers for predicting recurrence, TGCT patients are usually followed with active surveillance (16). ...
Radiomics refers to the extraction and analysis of a wide range of medical imaging features in a non-invasive and cost-effective manner to comprehensively characterise tumours. In this study, machine learning models combining radiomics and clinical factors were developed to predict retroperitoneal lymph node metastasis in testicular germ cell tumours (TGCTs), with the aim of reducing unnecessary treatment in this group of young patients. Ninety-one patients with surgically proven testicular germ cell tumours and contrast-enhanced CT were included in this retrospective study. After segmenting 273 retroperitoneal lymph nodes using dedicated radiomics software, we developed machine-learning prediction models using Random Forest (RF), Light Gradient Boosting Machine (LGBM), Support Vector Machine Classifier (SVC), and K-Nearest Neighbours (KNN). For each classifier, we developed a radiomics-only, clinical-only, and combined radiomics-clinical prediction model. The models’ performances were evaluated using the area under the receiver operating characteristic curves (AUCs). The RF-based combined clinical and radiomic model showed the most robust performance in predicting LNM with an area under the curve (AUC) of 0.95 (±0.03; 95% CI), accuracy 87%, precision 89%, recall 86% and F1 score 87%, followed by the LGBM model with an area under the curve (AUC) of 0.93 (±0.05; 95% CI), accuracy 83%, precision 87%, recall 80% and F1 score 82%. Decision curve analysis demonstrated the clinical utility of our proposed RF-based combined clinical–radiomics model. Our study has identified reliable and predictive machine-learning techniques for predicting lymph node metastasis in early-stage testicular cancer. Identifying the most effective machine-learning approaches for predictive analysis based on radiomics integrating clinical risk factors can expand the applicability of radiomics in precision oncology and cancer treatment. Multi-centre validation is required to provide high-quality evidence for clinical application.
... Testicular cancer accounts for 1% of newly diagnosed cancers in men worldwide. [1,2] In Southeast Asia, South-Central Asia, and Africa, the incidence-to-mortality ratio is 2:1. [3] These significantly improved outcomes are the result of sophisticated surgical techniques, tumor markers to guide treatment options, and platinum-based chemotherapy. ...
... [8] In seminoma stage 1, studies using one cycle of carboplatin reported a lower 5-year relapse rate of 3%-4% compared to 14%-16% with active surveillance. [1,3,18] Patients in stage 2 receive chemotherapy as well as RTR. Adjuvant chemotherapy reduces the risk of relapse, and primary retroperitoneal lymph node dissection for CS II seminoma has also been reported. ...
... [10] Patients with an ECOG score of 0-1 who received chemotherapy in stage 3 had a higher survival rate than patients with an ECOG score of >2 who underwent RTR but did not receive therapy for all types of testicular tumors. [1,3,18] It performed RTR on stage 3 nonseminoma and seminoma tumors with a history of testicular biopsy. [19,22] In this cohort, the overall 5-year survival rate for all testicular cancers was 83.9%. ...
... After orchiectomy, the probability of recurrence and metastasis in patients with stage I seminoma and patients with non-seminoma was 15-20% and ~30%, according to the European Guidelines for Urological Testicular Cancer [39]. Therefore, to explore the relationship between CSNK1G2-AS1 overexpression and the migrative and invasive abilities of TGCT cells, we performed transwell assays. ...
Background/Aim: Some long non-coding RNAs (lncRNAs) have been found to significantly participate in the progression of TGCTs. In comparison to the normal testis, the TGCT tissues showed significantly decreased CSNK1G2-AS1 expression, however, its effect on TGCTs and its mechanism are still unclear. The aim of this study is to investigate the effect of CSNK1G2-AS1 on TGCTs and explore the mechanism underlying its effect on TGCTs.
Materials and Methods: In this study, to evaluate the expression of CSNK1G2-AS1 in tissue samples from TGCTs, the UCSC and GEPIA databases were applied and qRT-PCR was conducted. The Kaplan-Meier Plotter was applied to analyze the correlation between CSNK1G2-AS1 methylation levels and the prognosis of TGCTs patients. The assays of MTS, clone formation, transwell, and flow cytometry were performed to investigate the effect of CSNK1G2-AS1 overexpression on the proliferation, metastasis, and apoptosis of TGCT cells, respectively. Finally, western blotting was conducted to determine the expressions of the proteins associated with EMT and AKT.
Results: Our study first found that, compared to the normal testis, TGCTs tissue showed significantly decreased CSNK1G2-AS1 expression, and hypomethylation of CSNK1G2-AS1 was significantly correlated with a better prognosis with TGCTs patients. In vitro, we found that overexpression of CSNK1G2-AS1 dramatically promoted the clone formation, invasion, and migration of TGCT cells, but inhibited apoptosis. And CSNK1G2-AS1 overexpression significantly decreased the expression of EMT-associated proteins ZO-1 but increased the expression and phosphorylation of AKT.
Conclusions: CSNK1G2-AS1 may play an essential role in the pathogenesis and metastasis of TGCTs through the EMT- and AKT-mediated signal pathways.
... Surgical exploration with a histopathological analysis was the most common and standard approach (reference test) to confirm tumors or malignancies (Table 4). Different guidelines were proposed to perform the histopathological analysis [68][69][70]. Nevertheless, due to the risks of surgery, the majority of studies (8/11) conducted the histopathological investigation only if tumors/malignancies were suspected in the ultrasound evaluation [47,48,[50][51][52][53][54]57] and some patients declined surgery, thus a histopathological analysis [49,52]. Only two studies verified both positives and negatives with a histopathological analysis [49,56] while Corcioni et al. [49] excluded patient data if histopathological investigation was not done. ...
Simple Summary
Testicular cancer is a prevalent malignancy in young men aged 15 to 35 years. Sonoelastography is an emerging technique for distinguishing between non-neoplasms, benignities, and malignancies by characterizing the tissue stiffness of testes. This review provides a summary of studies on the diagnostic accuracy of sonoelastography for identifying benign and malignant lesions, as well as tumors and non-tumors.
Abstract
The objective of this review was to summarize the applications of sonoelastography in testicular tumor identification and inquire about their test performances. Two authors independently searched English journal articles and full conference papers from CINAHL, Embase, IEEE Xplore®, PubMed, Scopus, and Web of Science from inception and organized them into a PIRO (patient, index test, reference test, outcome) framework. Eleven studies (n = 11) were eligible for data synthesis, nine of which (n = 9) utilized strain elastography and two (n = 2) employed shear-wave elastography. Meta-analyses were performed on the distinction between neoplasm (tumor) and non-neoplasm (non-tumor) from four study arms and between malignancy and benignity from seven study arms. The pooled sensitivity of classifying malignancy and benignity was 86.0% (95%CI, 79.7% to 90.6%). There was substantial heterogeneity in the classification of neoplasm and non-neoplasm and in the specificity of classifying malignancy and benignity, which could not be addressed by the subgroup analysis of sonoelastography techniques. Heterogeneity might be associated with the high risk of bias and applicability concern, including a wide spectrum of testicular pathologies and verification bias in the reference tests. Key technical obstacles in the index test were manual compression in strain elastography, qualitative observation of non-standardized color codes, and locating the Regions of Interest (ROI), in addition to decisions in feature extractions. Future research may focus on multiparametric sonoelastography using deep learning models and ensemble learning. A decision model on the benefits–risks of surgical exploration (reference test) could also be developed to direct the test-and-treat strategy for testicular tumors.
... For stage I-IIB testicular non-seminomatous germ cell tumor (NSGCT), retroperitoneal lymph node dissection (RPLND) is the recommended treatment, especially in patients with teratoma, according to guidelines published both in America and Europe [2,3]. Although both chemotherapy and RPLND are approved for primary treatment of NSGCT, for patients anxious about the potential long-term toxicities of cytotoxic drugs, surgery may be a preferred choice [4]. ...
... Although both chemotherapy and RPLND are approved for primary treatment of NSGCT, for patients anxious about the potential long-term toxicities of cytotoxic drugs, surgery may be a preferred choice [4]. To date, there are three surgical techniques for RPLND: open RPLND (O-RPLND), which is the standard procedure; laparoscopic RPLND (L-RPLND) and robotic RPLND (R-RPLND) as proper minimally invasive alternatives when access to particular expertise is available [3]. ...
Purpose:
To compare the perioperative outcomes of L-RPLND, R-RPLND and O-RPLND, and determine which one can be the mainstream option.
Methods:
We retrospectively reviewed medical records of 47 patients undergoing primary RPLND by three different surgical techniques for stage I-II NSGCT between July 2011 and April 2022 at our center. Standard open and laparoscopic RPLND was performed with usual equipment, and robotic RPLND was operated with da Vinci Si system.
Results:
Forty-seven patients underwent RPLND during 2011-2022, and 26 (55.3%) of them received L-RPLND, 14 (29.8%) were operated with robot, while 7 (14.9%) were performed O-RPLND. The median follow-up was 48.0 months, 48.0 months, and 60.0 months, respectively. The oncological outcomes were comparable among all groups. In L-RPLND group, there were 8 (30.8%) cases of low grade (Clavien I-II) complications, and 3 (11.5%) cases of high-grade (Clavien III-IV) complications. In R-RPLND group, one (7.1%) low-grade complication and four (28.6%) high-grade complications were observed. In O-RPLND group, there were 2 (28.5%) cases of low-grade complications and one case (14.2%) of high-grade one. The operation duration of L-RPLND was the shortest. In O-RPLND group, the number of positive lymph nodes were higher than other two groups. Patients undergoing open surgery had lower (p < 0.05) red blood cell count, hemoglobin level, and higher (p < 0.05) estimated blood loss, white blood cell count than those receiving either laparoscopic or robotic surgery.
Conclusion:
All three surgical techniques are comparable in safety, oncological, andrological, and reproductive outcomes under the circumstance of not using primary chemotherapy. L-RPLND might be the most cost-effective option.
... While the rising incidence over recent decades [2,3] continues, prospects of a cure after treatment remain high, with overall long-term survival of 97%. Current evidence suggests that optimal outcomes are obtained in high-volume reference centres, irrespective of disease stage [4]. ...
... Patients with TC usually present with a painless testicular mass or an incidental finding on testicular ultrasound (US). Clinical assessment should include examination of both testes, the abdomen, and the supraclavicular fossae, as well as the chest to identify gynaecomastia [4]. ...
... Up to 30% of patients with clinical stage I NSGCT have occult metastatic disease and will experience relapse after orchidectomy alone [4]. ...
Context:
Each year the European Association of Urology (EAU) produce a document based on the most recent evidence on the diagnosis, therapy, and follow-up of testicular cancer (TC).
Objective:
To represent a summarised version of the EAU guidelines on TC for 2023 with a focus on key changes in the 2023 update.
Evidence acquisition:
A multidisciplinary panel of TC experts, comprising urologists, medical and radiation oncologists, and pathologists, reviewed the results from a structured literature search to compile the guidelines document. Each recommendation in the guidelines was assigned a strength rating.
Evidence synthesis:
For the 2023 EAU guidelines on TC, a review and restructure were undertaken. The key changes incorporated in the 2023 update include: new supporting text regarding venous thromboembolism prophylaxis in males with metastatic germ cell tumours receiving chemotherapy; quality of life after treatment; an update of the histological classifications and inclusion of the World Health Organization 2022 pathological classification; inclusion of the revalidation of the 1997 International Germ Cell Cancer Collaborative Group prognostic risk factors; and a new section covering oncology treatment protocols.
Conclusions:
The 2023 version of the EAU guidelines on TC include the highest available scientific evidence to standardise the management of TC. Better stratification and optimisation of treatment modalities will continue to improve the high survival rates for patients with TC.
Patient summary:
This article presents a summary of the European Association of Urology guidelines on testicular cancer published in 2023 and includes the latest recommendations for management of this disease. The guidelines are a valuable resource that may help patients in understanding treatment recommendations.
