Impact of age on clinicopathological outcomes and recurrence-free survival after the surgical management of nonseminomatous germ cell tumour
Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY Department of Urology, Indiana University Medical Center, Indianapolis, IN Department of Medicine, Genitourinary Oncology Service, Memorial Sloan-Kettering Cancer Center (MSKCC), New York, NY, USA.BJU International (Impact Factor: 3.53). 03/2012; 110(7):950-5. DOI: 10.1111/j.1464-410X.2012.10947.x
OBJECTIVE To determine the impact of age on clinicopathological findings and disease recurrence in men with nonseminomatous germ cell tumour (NSGCT) undergoing retroperitoneal lymph node dissection (RPLND). PATIENTS AND METHODS We identified 1246 patients with NSGCT who underwent either primary or post-chemotherapy-RPLND (PC-RPLND) between 1989 and 2006 from our prospective testis cancer database. Perioperative characteristics were compared among men aged < or >= 50 years. Multivariable models were used to evaluate the association of age with disease-free survival, controlling for established clinical and pathological features. RESULTS Of 514 men undergoing primary and 732 men undergoing PC-RPLND, 12 (2.3%) and 23 (3.1%) were aged >= 50 years, respectively. There were no significant differences between men aged < or >= 50 years for perioperative clinicopathological characteristics, with the exception of pre-RPLND CT nodal size. The pathological distributions at primary RPLND were similar in men aged < or >= 50 years. After PC-RPLND, there were no differences in RPLND histology, number of lymph nodes resected, estimated blood loss, hospital stay, or perioperative complication rate. Age at surgery was not a significant predictor of disease recurrence when subjected to a multivariable analysis. CONCLUSIONS Our data suggests that age at RPLND does not predict for disease recurrence and men aged >= 50 years had similar pre- and postoperative characteristics to those aged <50 years. We conclude that RPLND can be safely performed in men aged >= 50 years and these patients should be offered optimal treatment regimens for NSGCT as directed according to established guidelines.
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ABSTRACT: This overview discusses several important developments in testicular germ cell tumors in the past year. Genomic studies continue to investigate gene expression as possible markers for disease relapse and chemotherapy resistance. Optimal treatment strategies for early-stage seminomas are evolving toward surveillance versus chemotherapy and away from radiation, and the role of retroperitoneal lymph node dissection in disseminated nonseminomatous cancers in complete remission is becoming less certain. Treatment and surveillance paradigms continue to be defined and refined for both early and late-stage disease as research in these areas continues and the data from multiple large studies mature.Current opinion in oncology 02/2012; 24(3):266-71. DOI:10.1097/CCO.0b013e32835167fc · 4.47 Impact Factor
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ABSTRACT: Neoplasms in the testis and in the testicular adnexa of elderly patients are completely different from those observed in younger patients. Indeed, although conventional seminomas and nonseminomas are mainly observed in the age range of 20-45 years, spermatocytic seminoma, malignant Leydig tumors, and lymphomas in the testis and sarcomas in the paratesticular region are encountered in individuals older than 60 years of age. Here, we discuss the testis and paratesticular region neoplasm more commonly diagnosed in elderly men.Anti-cancer drugs 10/2012; 24(3). DOI:10.1097/CAD.0b013e32835a3598 · 1.78 Impact Factor
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