Skip to main content

Advertisement

SpringerLink
Log in

Factors that impact the outcomes in testicular germ cell tumors in low–middle-income countries

  • Original Paper
  • Published:
Medical Oncology Aims and scope Submit manuscript

Abstract

Germ cell tumors (GCTs) are one of the most common tumors in adolescents and young adults. There is paucity of data on GCT from low–middle-income countries (LMIC). The present study was conducted to assess the demographic features, clinical manifestations, pathology, and outcomes of GCT patients treated at our center. Patients with testicular GCT above the age of 18 years, treated at our center from 2001 to 2015 were included in the study. Data were extracted retrospectively from the case records. Event-free survival (EFS) and overall survival (OS) were calculated using the Kaplan–Meier method and the variables were compared using the log-rank test. The study included 421 patients among whom 128 (30%) had a histological diagnosis of seminoma and 293 (70%) had non-seminomatous germ cell tumor (NSGCT). Metastatic disease at presentation was observed in 83/128 (65%) with seminoma and 254/293 (87%) with NSGCT. According to the International Germ Cell Cancer Collaborative Group (IGCCCG) risk stratification for metastatic disease, good- and intermediate-risk seminoma were observed in 55/83 (66%) and 28/83 (34%) patients, respectively, and good-, intermediate-, and poor-risk NSGCT were observed in 82/254 (32%), 76/254 (30%), and 96/254 (38%) patients, respectively. The median follow-up was 32.3 months (range 0.03–200 months). The 3-year OS for the entire cohort was 80.3%. The 3-year OS for seminoma was 91.4%, and for NSGCT was 75.3%. Factors significantly associated with inferior EFS and OS on multivariate analysis included poor performance status, scrotal orchidectomy, carboplatin-based regimen, NSGCT histology, and treatment default. Patients with testicular GCT in India present in an advanced stage and higher IGCCCG risk compared to Western data. Factors unique to LMIC like treatment default, bulky disease, dose compromise, and scrotal orchidectomy have a negative impact on the outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63:11–30.

    Article  Google Scholar 

  2. Bosl GJ, Motzer RJ. Testicular germ-cell cancer. N Engl J Med. 1997;337:242–54.

    Article  CAS  Google Scholar 

  3. Hanna NH, Einhorn LH. Testicular cancer-discoveries and updates. N Engl J Med. 2014;371:2005–16.

    Article  Google Scholar 

  4. International Germ Cell Consensus Classification. Prognostic factor-based staging system for metastatic germ cell cancers. International Germ Cell Cancer Collaborative Group. J Clin Oncol. 1997;15:594–603.

    Article  Google Scholar 

  5. Culine S, Kerbrat P, Kramar A, Théodore C, Chevreau C, Geoffrois, et al. Refining the optimal chemotherapy regimen for good-risk metastatic non seminomatous germ-cell tumors: a randomized trial of the Genito-Urinary Group of the French Federation of Cancer Centers (GETUG T93BP). Ann Oncol. 2007;18:917–24.

    Article  CAS  Google Scholar 

  6. Williams SD, Birch R, Einhorn LH, Irwin L, Greco FA, Loehrer PJ. Treatment of disseminated germ-cell tumors with cisplatin, bleomycin, and either vinblastine or etoposide. N Engl J Med. 1987;316:1435–40.

    Article  CAS  Google Scholar 

  7. de Wit R, Stoter G, Kaye SB, Sleijfer DT, Jones WG, ten Bokkel Huinink WW, et al. Importance of bleomycin in combination chemotherapy for good-prognosis testicular nonseminoma: a randomized study of the European Organization for Research and Treatment of Cancer Genitourinary Tract Cancer Cooperative Group. J Clin Oncol. 1997;15:1837–43.

    Article  Google Scholar 

  8. Loehrer PJ, Johnson D, Elson P, Einhorn LH, Trump D. Importance of bleomycin in favorable-prognosis disseminated germ cell tumors: an Eastern Cooperative Oncology Group trial. J Clin Oncol. 1995;13:470–6.

    Article  Google Scholar 

  9. Saxman SB, Finch D, Gonin R, Einhorn LH. Long-term follow-up of a phase III study of three versus four cycles of bleomycin, etoposide, and cisplatin in favorable-prognosis germ-cell tumors: the Indian University experience. J Clin Oncol. 1998;16:702–6.

    Article  CAS  Google Scholar 

  10. Xiao H, Mazumdar M, Bajorin DF, Sarosdy M, Vlamis V, Spicer J, et al. Long-term follow-up of patients with good-risk germ cell tumors treated with etoposide and cisplatin. J Clin Oncol. 1997;15:2553–8.

    Article  CAS  Google Scholar 

  11. Schmoll HJ, Jordan K, Huddart R, Laguna MP, Horwich A, Fizazi K, et al. Testicular non-seminoma: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol. 2009;20(Suppl 4):89–96.

    PubMed  Google Scholar 

  12. Oliver RT, Mead GM, Rustin GJ, Joffe JK, Aass N, Coleman R, et al. Randomized trial of carboplatin versus radiotherapy for stage I seminoma: mature results on relapse and contralateral testis cancer rates in MRC TE19/EORTC 30982 study (ISRCTN27163214). J Clin Oncol. 2011;29:957–62.

    Article  CAS  Google Scholar 

  13. Cancer incidence in India. Globocan 2018. http://www.gco.iarc.fr. Accessed 22 Dec 2018.

  14. Raina V, Shukla NK, Rath GK, Gupta NP, Mishra MC, Chaterjee TK, et al. Clinical profile and problems of management of 108 cases of germ cell tumours of testis at Institute Rotary Cancer Hospital, All India Institute of Medical Sciences New Delhi 1985–1990. Br J Cancer. 1993;67:573–7.

    Article  CAS  Google Scholar 

  15. Raina V, Shukla NK, Gupta NP, Deo S, Rath GK. Germ cell tumours in uncorrected cryptorchid testis at Institute Rotary Cancer Hospital, New Delhi. Br J Cancer. 1995;71:380–2.

    Article  CAS  Google Scholar 

  16. Joshi A, Zanwar S, Shetty N, Patil V, Noronha V, Bakshi G, et al. Epidemiology of male seminomatous and nonseminomatous germ cell tumors and response to first-line chemotherapy from a tertiary cancer center in India. Indian J Cancer. 2016;53:313–6.

    Article  CAS  Google Scholar 

  17. Bhutani M, Kumar L, Seth A, Thulkar S, Vijayaraghavan M, Kochupillai V. Germ cell tumours of the testis: clinical features, treatment outcome and prognostic factors. Natl Med J India. 2002;15:18–21.

    PubMed  Google Scholar 

  18. Albany C, Adra N, Snavely AC, Cary C, Masterson TA, Foster RS, et al. Multidisciplinary clinic approach improves overall survival outcomes of patients with metastatic germ-cell tumors. Ann Oncol. 2018;29:341–6.

    Article  CAS  Google Scholar 

  19. Ghazarian AA, Trabert B, Devesa SS, McGlynn KA. Recent trends in the incidence of testicular germ cell tumors in the United States. Andrology. 2015;3:13–8.

    Article  CAS  Google Scholar 

  20. Boileau MA, Steers WD. Testis tumors: the clinical significance of the tumor-contaminated scrotum. J Urol. 1984;132:51–4.

    Article  CAS  Google Scholar 

  21. Capelouto C, Clark P, Ransil B, Loughlin K. Original articles: testis cancer: a review of scrotal violation in testicular cancer: is adjuvant local therapy necessary? J Urol. 1995;153:981–5.

    Article  CAS  Google Scholar 

  22. Groot HJ, Lubberts S, de Wit R, Witjes JA, Kerst JM, de Jong IJ, et al. Risk of solid cancer after treatment of testicular germ cell cancer in the platinum era. J Clin Oncol. 2018;36:2504–13.

    Article  CAS  Google Scholar 

  23. Bajorin DF, Sarosdy MF, Pfister DG, Mazumdar M, Motzer RJ, Scher HI, et al. Randomized trial of etoposide and cisplatin versus etoposide and carboplatin in patients with good-risk germ cell tumors: a multiinstitutional study. J Clin Oncol. 1993;11:598–606.

    Article  CAS  Google Scholar 

  24. Horwich A, Sleijfer DT, Fossa SD, Kaye SB, Oliver RT, Cullen MH, et al. Randomized trial of bleomycin, etoposide, and cisplatin compared with bleomycin, etoposide, and carboplatin in good-prognosis metastatic nonseminomatous germ cell cancer: a multiinstitutional Medical Research Council/European Organization for Research and Treatment of Cancer trial. J Clin Oncol. 1997;15:1844–52.

    Article  CAS  Google Scholar 

  25. Mann JR, Raafat F, Robinson K, Imeson J, Gornall P, Phillips M, et al. UKCCSG’s germ cell tumour (GCT) studies: improving outcome for children with malignant extracranial non-gonadal tumours–carboplatin, etoposide, and bleomycin are effective and less toxic than previous regimens. United Kingdom Children’s Cancer Study Group. Med Pediatr Oncol. 1998 Apr;30(4):217–27.

    Article  CAS  Google Scholar 

  26. Frazier AL, Stoneham S, Rodriguez-Galindo C, Dang H, Xia C, Olson TA, et al. Comparison of carboplatin versus cisplatin in the treatment of paediatric extracranial malignant germ cell tumours: a report of the Malignant Germ Cell International Consortium. Eur J Cancer. 2018;98:30–7.

    Article  CAS  Google Scholar 

  27. Adra N, Abonour R, Althouse SK, Albany C, Hanna NH, Einhorn LH. High-dose chemotherapy and autologous peripheral-blood stem-cell transplantation for relapsed metastatic germ cell tumors: the indiana university experience. J Clin Oncol. 2017;35:1096–102.

    Article  Google Scholar 

  28. Surveillance Epidemiology and End Results (SEER) Program (www.seer.cancer.gov) Research Data (1973–2014), National Cancer Institute, DCCPS, Surveillance Research Program, released April 2017, based on the November 2016 Submission.

Download references

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, 600020, India

    S. V. Saju, Venkatraman Radhakrishnan, Trivadi S. Ganesan, Manikandan Dhanushkodi & Tenali Gnana Sagar

  2. Surgical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India

    Anand Raja

  3. Radiotherapy, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India

    Ganesarajah Selvaluxmy

Authors
  1. S. V. Saju
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Venkatraman Radhakrishnan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Trivadi S. Ganesan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Manikandan Dhanushkodi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anand Raja
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ganesarajah Selvaluxmy
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tenali Gnana Sagar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Venkatraman Radhakrishnan.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Informed consent and ethical approval

The study is retrospective in nature and therefore ethics committee approval and patient consent are not required as per Cancer Institute ethics committee policy.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Saju, S.V., Radhakrishnan, V., Ganesan, T.S. et al. Factors that impact the outcomes in testicular germ cell tumors in low–middle-income countries. Med Oncol 36, 28 (2019). https://doi.org/10.1007/s12032-019-1252-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12032-019-1252-6

Keywords

Search

Navigation