When is a Seminoma not a Seminoma? The Incidence, Risk Factors and Management of Patients With Testicular Seminoma With Discordant Elevated Serum Alpha-fetoprotein
To describe the incidence, clinical and demographic factors, and treatment patterns associated with discordant elevated alpha-fetoprotein (AFP) findings in patients with pure seminomatous histology. We queried the National Cancer Database to identify patients with testicular germ cell tumors (GCT) d...
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| Veröffentlicht in: | Urology (Ridgewood, N.J.) N.J.), 2021-11, Vol.157, p.188-196 |
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| creator | Fero, Katherine E. Lec, Patrick M. Sharma, Vidit Lenis, Andrew T. Low, Josiah Litwin, Mark S. Leapman, Michael S. Chamie, Karim |
| description | To describe the incidence, clinical and demographic factors, and treatment patterns associated with discordant elevated alpha-fetoprotein (AFP) findings in patients with pure seminomatous histology.
We queried the National Cancer Database to identify patients with testicular germ cell tumors (GCT) diagnosed in 2011-2015. Patients were grouped based on histologic diagnosis and pre-operative serum AFP level.
Of 18,616 patients diagnosed with testicular GCT, 53% (N = 9,849) had pure seminomatous histology, of whom 8.3% (N = 821) had an elevated serum AFP pre-operatively. Non-white patients with seminoma were more likely to have a pre-op elevated AFP (OR 1.42; 95% CI: 1.10-1.83); patients treated at higher volume centers were less likely to have a pre-op elevated AFP (0.66, 95% CI: 0.53-0.83). Patients with seminoma with elevated AFP received adjuvant radiation more frequently than those with NSGCT (Stage I: 15% vs 0.2%, P |
| doi_str_mv | 10.1016/j.urology.2021.05.101 |
| format | Article |
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We queried the National Cancer Database to identify patients with testicular germ cell tumors (GCT) diagnosed in 2011-2015. Patients were grouped based on histologic diagnosis and pre-operative serum AFP level.
Of 18,616 patients diagnosed with testicular GCT, 53% (N = 9,849) had pure seminomatous histology, of whom 8.3% (N = 821) had an elevated serum AFP pre-operatively. Non-white patients with seminoma were more likely to have a pre-op elevated AFP (OR 1.42; 95% CI: 1.10-1.83); patients treated at higher volume centers were less likely to have a pre-op elevated AFP (0.66, 95% CI: 0.53-0.83). Patients with seminoma with elevated AFP received adjuvant radiation more frequently than those with NSGCT (Stage I: 15% vs 0.2%, P <.01; Stage II: 21.9% vs 0.1%, P <.01) and less frequently underwent retroperitoneal lymph node dissection (RPLND) (Stage 1: 1.9% vs 11.1% P <.01; Stage II: 8.8% vs 17.4%, P <.01).
The detection of elevated serum alpha-fetoprotein (AFP) in patients with pure seminomatous testicular germ cell tumors (GCT) is a discordant finding that implies the presence of occult non-seminomatous GCT (NSGCT) elements. 8% of patients with pure seminomatous GCTs had diagnostically discordant elevated pre-operative AFP levels. Despite recommendations to manage these patients as NSGCT, patients with seminoma and elevated AFP were managed in a fashion comparable to those with seminoma and normal AFP levels.</description><identifier>ISSN: 0090-4295</identifier><identifier>EISSN: 1527-9995</identifier><identifier>DOI: 10.1016/j.urology.2021.05.101</identifier><identifier>PMID: 34389428</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; alpha-Fetoproteins - metabolism ; Chemotherapy, Adjuvant - statistics & numerical data ; Databases, Factual ; Hospitals, High-Volume ; Humans ; Lymph Node Excision - statistics & numerical data ; Male ; Neoplasm Staging ; Orchiectomy - statistics & numerical data ; Preoperative Period ; Proportional Hazards Models ; Race Factors ; Radiotherapy, Adjuvant - statistics & numerical data ; Retrospective Studies ; Seminoma - blood ; Seminoma - pathology ; Seminoma - therapy ; Survival Rate ; Testicular Neoplasms - blood ; Testicular Neoplasms - pathology ; Testicular Neoplasms - therapy ; United States</subject><ispartof>Urology (Ridgewood, N.J.), 2021-11, Vol.157, p.188-196</ispartof><rights>2021 Elsevier Inc.</rights><rights>Copyright © 2021 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c313t-e500a6aa89a7c5973b92c42c89a02a6d84ecd0ce9de8c91e611402c77655a6003</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S009042952100738X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34389428$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fero, Katherine E.</creatorcontrib><creatorcontrib>Lec, Patrick M.</creatorcontrib><creatorcontrib>Sharma, Vidit</creatorcontrib><creatorcontrib>Lenis, Andrew T.</creatorcontrib><creatorcontrib>Low, Josiah</creatorcontrib><creatorcontrib>Litwin, Mark S.</creatorcontrib><creatorcontrib>Leapman, Michael S.</creatorcontrib><creatorcontrib>Chamie, Karim</creatorcontrib><title>When is a Seminoma not a Seminoma? The Incidence, Risk Factors and Management of Patients With Testicular Seminoma With Discordant Elevated Serum Alpha-fetoprotein</title><title>Urology (Ridgewood, N.J.)</title><addtitle>Urology</addtitle><description>To describe the incidence, clinical and demographic factors, and treatment patterns associated with discordant elevated alpha-fetoprotein (AFP) findings in patients with pure seminomatous histology.
We queried the National Cancer Database to identify patients with testicular germ cell tumors (GCT) diagnosed in 2011-2015. Patients were grouped based on histologic diagnosis and pre-operative serum AFP level.
Of 18,616 patients diagnosed with testicular GCT, 53% (N = 9,849) had pure seminomatous histology, of whom 8.3% (N = 821) had an elevated serum AFP pre-operatively. Non-white patients with seminoma were more likely to have a pre-op elevated AFP (OR 1.42; 95% CI: 1.10-1.83); patients treated at higher volume centers were less likely to have a pre-op elevated AFP (0.66, 95% CI: 0.53-0.83). Patients with seminoma with elevated AFP received adjuvant radiation more frequently than those with NSGCT (Stage I: 15% vs 0.2%, P <.01; Stage II: 21.9% vs 0.1%, P <.01) and less frequently underwent retroperitoneal lymph node dissection (RPLND) (Stage 1: 1.9% vs 11.1% P <.01; Stage II: 8.8% vs 17.4%, P <.01).
The detection of elevated serum alpha-fetoprotein (AFP) in patients with pure seminomatous testicular germ cell tumors (GCT) is a discordant finding that implies the presence of occult non-seminomatous GCT (NSGCT) elements. 8% of patients with pure seminomatous GCTs had diagnostically discordant elevated pre-operative AFP levels. Despite recommendations to manage these patients as NSGCT, patients with seminoma and elevated AFP were managed in a fashion comparable to those with seminoma and normal AFP levels.</description><subject>Adult</subject><subject>alpha-Fetoproteins - metabolism</subject><subject>Chemotherapy, Adjuvant - statistics & numerical data</subject><subject>Databases, Factual</subject><subject>Hospitals, High-Volume</subject><subject>Humans</subject><subject>Lymph Node Excision - statistics & numerical data</subject><subject>Male</subject><subject>Neoplasm Staging</subject><subject>Orchiectomy - statistics & numerical data</subject><subject>Preoperative Period</subject><subject>Proportional Hazards Models</subject><subject>Race Factors</subject><subject>Radiotherapy, Adjuvant - statistics & numerical data</subject><subject>Retrospective Studies</subject><subject>Seminoma - blood</subject><subject>Seminoma - pathology</subject><subject>Seminoma - therapy</subject><subject>Survival Rate</subject><subject>Testicular Neoplasms - blood</subject><subject>Testicular Neoplasms - pathology</subject><subject>Testicular Neoplasms - therapy</subject><subject>United States</subject><issn>0090-4295</issn><issn>1527-9995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUU1v1DAQtRCILoWfAPKRA1nGTuzEp6oqLVQqAsGiHi3Xnu16SeKt7VTq7-GP4rDLx42T5-O9eTN-hLxksGTA5NvtcoqhD7cPSw6cLUHM5UdkwQRvK6WUeEwWAAqqhitxRJ6ltAUAKWX7lBzVTd2phncL8uN6gyP1iRr6FQc_hsHQMeR_0hO62iC9HK13OFp8Q7_49J1eGJtDLLTR0Y9mNLc44JhpWNPPJvsSJnrt84auMGVvp97Ev_N_Nd75ZEN0ppDOe7w3GV1BxGmgp_1uY6o15rCLIaMfn5Mna9MnfHF4j8m3i_PV2Yfq6tP7y7PTq8rWrM4VCgAjjemUaa1QbX2juG24LTlwI13XoHVgUTnsrGIoGWuA27aVQhgJUB-T1_u5RfduKovroSyJfW9GDFPSXEjWdJ2QXYGKPdTGkFLEtd5FP5j4oBno2R-91Qd_9OyPBjGXC-_VQWK6GdD9Yf02pABO9gAsh957jDpZP_-78xFt1i74_0j8BFXapi4</recordid><startdate>202111</startdate><enddate>202111</enddate><creator>Fero, Katherine E.</creator><creator>Lec, Patrick M.</creator><creator>Sharma, Vidit</creator><creator>Lenis, Andrew T.</creator><creator>Low, Josiah</creator><creator>Litwin, Mark S.</creator><creator>Leapman, Michael S.</creator><creator>Chamie, Karim</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202111</creationdate><title>When is a Seminoma not a Seminoma? The Incidence, Risk Factors and Management of Patients With Testicular Seminoma With Discordant Elevated Serum Alpha-fetoprotein</title><author>Fero, Katherine E. ; Lec, Patrick M. ; Sharma, Vidit ; Lenis, Andrew T. ; Low, Josiah ; Litwin, Mark S. ; Leapman, Michael S. ; Chamie, Karim</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c313t-e500a6aa89a7c5973b92c42c89a02a6d84ecd0ce9de8c91e611402c77655a6003</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>alpha-Fetoproteins - metabolism</topic><topic>Chemotherapy, Adjuvant - statistics & numerical data</topic><topic>Databases, Factual</topic><topic>Hospitals, High-Volume</topic><topic>Humans</topic><topic>Lymph Node Excision - statistics & numerical data</topic><topic>Male</topic><topic>Neoplasm Staging</topic><topic>Orchiectomy - statistics & numerical data</topic><topic>Preoperative Period</topic><topic>Proportional Hazards Models</topic><topic>Race Factors</topic><topic>Radiotherapy, Adjuvant - statistics & numerical data</topic><topic>Retrospective Studies</topic><topic>Seminoma - blood</topic><topic>Seminoma - pathology</topic><topic>Seminoma - therapy</topic><topic>Survival Rate</topic><topic>Testicular Neoplasms - blood</topic><topic>Testicular Neoplasms - pathology</topic><topic>Testicular Neoplasms - therapy</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fero, Katherine E.</creatorcontrib><creatorcontrib>Lec, Patrick M.</creatorcontrib><creatorcontrib>Sharma, Vidit</creatorcontrib><creatorcontrib>Lenis, Andrew T.</creatorcontrib><creatorcontrib>Low, Josiah</creatorcontrib><creatorcontrib>Litwin, Mark S.</creatorcontrib><creatorcontrib>Leapman, Michael S.</creatorcontrib><creatorcontrib>Chamie, Karim</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Urology (Ridgewood, N.J.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fero, Katherine E.</au><au>Lec, Patrick M.</au><au>Sharma, Vidit</au><au>Lenis, Andrew T.</au><au>Low, Josiah</au><au>Litwin, Mark S.</au><au>Leapman, Michael S.</au><au>Chamie, Karim</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>When is a Seminoma not a Seminoma? The Incidence, Risk Factors and Management of Patients With Testicular Seminoma With Discordant Elevated Serum Alpha-fetoprotein</atitle><jtitle>Urology (Ridgewood, N.J.)</jtitle><addtitle>Urology</addtitle><date>2021-11</date><risdate>2021</risdate><volume>157</volume><spage>188</spage><epage>196</epage><pages>188-196</pages><issn>0090-4295</issn><eissn>1527-9995</eissn><abstract>To describe the incidence, clinical and demographic factors, and treatment patterns associated with discordant elevated alpha-fetoprotein (AFP) findings in patients with pure seminomatous histology.
We queried the National Cancer Database to identify patients with testicular germ cell tumors (GCT) diagnosed in 2011-2015. Patients were grouped based on histologic diagnosis and pre-operative serum AFP level.
Of 18,616 patients diagnosed with testicular GCT, 53% (N = 9,849) had pure seminomatous histology, of whom 8.3% (N = 821) had an elevated serum AFP pre-operatively. Non-white patients with seminoma were more likely to have a pre-op elevated AFP (OR 1.42; 95% CI: 1.10-1.83); patients treated at higher volume centers were less likely to have a pre-op elevated AFP (0.66, 95% CI: 0.53-0.83). Patients with seminoma with elevated AFP received adjuvant radiation more frequently than those with NSGCT (Stage I: 15% vs 0.2%, P <.01; Stage II: 21.9% vs 0.1%, P <.01) and less frequently underwent retroperitoneal lymph node dissection (RPLND) (Stage 1: 1.9% vs 11.1% P <.01; Stage II: 8.8% vs 17.4%, P <.01).
The detection of elevated serum alpha-fetoprotein (AFP) in patients with pure seminomatous testicular germ cell tumors (GCT) is a discordant finding that implies the presence of occult non-seminomatous GCT (NSGCT) elements. 8% of patients with pure seminomatous GCTs had diagnostically discordant elevated pre-operative AFP levels. Despite recommendations to manage these patients as NSGCT, patients with seminoma and elevated AFP were managed in a fashion comparable to those with seminoma and normal AFP levels.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>34389428</pmid><doi>10.1016/j.urology.2021.05.101</doi><tpages>9</tpages></addata></record> |
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| subjects | Adult alpha-Fetoproteins - metabolism Chemotherapy, Adjuvant - statistics & numerical data Databases, Factual Hospitals, High-Volume Humans Lymph Node Excision - statistics & numerical data Male Neoplasm Staging Orchiectomy - statistics & numerical data Preoperative Period Proportional Hazards Models Race Factors Radiotherapy, Adjuvant - statistics & numerical data Retrospective Studies Seminoma - blood Seminoma - pathology Seminoma - therapy Survival Rate Testicular Neoplasms - blood Testicular Neoplasms - pathology Testicular Neoplasms - therapy United States |
| title | When is a Seminoma not a Seminoma? The Incidence, Risk Factors and Management of Patients With Testicular Seminoma With Discordant Elevated Serum Alpha-fetoprotein |
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