Elsevier

European Urology

Volume 42, Issue 6, December 2002, Pages 553-563
European Urology

Clinical Pattern and Therapeutic Results Achieved in 1490 Patients with Germ-Cell Tumours of the Testis: the Experience of the Spanish Germ-Cell Cancer Group (GG)

https://doi.org/10.1016/S0302-2838(02)00439-6Get rights and content

Abstract

Objective: To describe the clinical characteristics and treatment results obtained with the application of a homogeneous treatment protocol in 1490 patients with germ-cell tumours (GCT) registered in the 55 hospitals belonging to the Spanish Germ-Cell Cancer Group (GG) during the period between January 1994 and April 2001.

Methods: In general, surveillance was the common policy for stage I patients without local poor prognosis factors, whereas they received adjuvant chemotherapy in case those factor were present. Chemotherapy schedules used in advanced cases were cisplatin and etoposide (EP) for seminoma and BEP or BOMP-EPI in non-seminoma, according to whether the patient was in the good or poor prognosis IGCCCG (International Germ-Cell Cancer Collaborative Group) group. Excision of residual masses was mandatory in non-seminomatous germ-cell tumour (NSGCT).

Results: Initial local symptomatology was increased testis size in 90% of cases. Sonography was an excellent diagnostic tool to suggest tumour. Non-seminoma (64.2%) was more frequent than seminoma (35.8%). Approximately 10% had the antecedent of cryptorchidism. Non-seminoma patients were 7 years younger than seminoma. Right testis was involved predominantly. Pre-orchidectomy tumour markers were elevated in 21% of seminoma (βHGC) and 79% in non-seminoma (αFP and/or βHGC). Scrotum violation occurred in only 1.8%. There were significant differences among stage I and the IGCCCG prognosis groups related to a longer interval between the first symptom and orchiectomy. Eighteen percent of non-seminomatous germ-cell tumour belonged to the poor prognosis IGCCCG group. With a median follow-up to 33 months, this series has achieved a 3 year overall survival of 98% for seminoma and 94% for non-seminoma. Only 10% of excised residual masses present after chemotherapy contained malignant cells.

Conclusion: Spanish GCT have a similar clinical pattern to that described in the other occidental countries except for a slight increased proportion of non-seminoma upon seminoma. Co-operative groups as GG are unique structures to obtain quick and wide experience on the treatment of testis tumours, contributing to achieve a high cure rate.

Introduction

Testis cancer is a rare neoplasm. As it is well known, germ-cell tumours (GCT) represents more than 90% of tumours localised in the testis. The incidence of this neoplasm ranges from 1.5 to 9 per 100,000. Spain is among the countries in Europe where the incidence is lowest: 1.5–2 per 100,000 [1]. Despite its low incidence, GCT is significant due to its presentation in the young population and its high cure rate.

The Spanish Germ-Cell Cancer Group (GG) joins the efforts of 55 Spanish hospitals to share their experience on the diagnosis and treatment of these very special neoplasms. Starting its joint adventure at the beginning of 1994, GG has so far accrued nearly 1500 patients with testicular GCT. The clinical characteristics of the patients and the results achieved with the use of a protocolized treatment schedule are reported in this paper.

Section snippets

Methods

During the period between January 1994 and April 2001, 1490 patients with germ-cell testicular tumours were registered in the 55 hospitals belonging to Spanish Germ-Cell Cancer Group (GG). Cases were grouped according to the pathological classification of Mostofi and Sobin [2] further adopted by WHO. Initial work-up for all histologies included complete blood count, chest X-ray, abdominal CT scan and serum determination of βHCG, α-fetoprotein and LDH. Only in the case of non-seminomatous

Clinical features

Table 1 shows the number of patients included annually in the GG registry in the period 1994–2001. The table also shows the distribution between seminoma and non-seminoma in the 1490 cases registered in that period. Non-seminoma accounted for 64.2% of the cases (957), and seminoma for 35.8% (533). All cases of seminoma with elevation of α-fetoprotein were considered and treated as non-seminoma.

The median age for non-seminoma patients was 26 years (range 18–74) and for seminoma 33 years (range

Discussion

Spain has a male population of approximately 19,000,000. Therefore, the number of testicular GCT expected for the whole country, considering its incidence is between 1.5 and 2 per 100,000, ranging from 290 to 380 new cases per year. This data would give an estimate of 2000–2600 new cases in the period studied. The GG has registered nearly 1500 new cases in the last 7 years, which can be regarded as representative and provide a proper description of the disease as it now occurs in Spain.

In

Acknowledgements

The authors are grateful to Dra Ana Montes and Teresa Fuentes for her contribution in manuscript preparation.

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