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Orchidopexy for congenital cryptorchidism in childhood and adolescence and testicular cancer in adults: an updated systematic review and meta-analysis of observational studies

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Abstract

Congenital cryptorchidism is a well-established risk factor of testicular malignancies. However, there is still remarkable variability in the measures of associations between of these two clinical entities. The current meta-analysis investigates the up-to-date risk of testicular cancer in adults with a history of surgically corrected congenital cryptorchidism until adolescence. The meta-analysis was conducted with strict criteria for the identification of the congenital cryptorchidism cases that underwent surgery before adulthood. The study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of the PubMed and the Scopus databases was conducted, using a defined strategy, from inception to February 2023. Two independent authors screened the literature and extracted the data, using inclusion and exclusion criteria. Of the 2176 articles identified, 93 articles were fully retrieved, and 6 articles met all the inclusion criteria. The Newcastle–Ottawa scale was applied for the studies’ quality assessment. The random-effects model in RevMan 5.4 program was used for the meta-analysis. Three case–control studies and three cohort studies were selected. They included 371,681 patients and 1786 incidents of testicular cancer. The pooled odds ratio (OR) was 3.99 (95% confidence intervals (CI): 2.80–5.71). The heterogeneity was moderate and estimated at 51% with the I-squared statistic. A forest plot and a funnel plot were produced to evaluate the ORs and the probable publication bias, respectively. The mean Newcastle–Ottawa score was 8/9 for all the included reports.

  Conclusion: This systematic review and meta-analysis verifies, with an updated estimate, the increased risk of testicular cancer in adults with an orchidopexy history. New evidence on the maldescent laterality supports that the cancer risk remains increased and for the contralateral, unaffected testicle, although to a lesser extent. The orchidopexy in the first year of life prevents the testicular damage and decreases the overall cancer risk.

What is Known:

• Congenital cryptorchidism is the commonest genitourinary abnormality and a risk factor for testicular cancer.

• The most recent meta-analysis reporting this association was in 2013.

What is New:

• After reviewing literature until February 2023, the association of congenital cryptorchidism with testicular cancer risk in adulthood was verified: odds ratio=3.99 [2.80–5.71], 95% CI.

• The meta-analysis highlights the protective role of early orchidopexy and the controversial data about maldescent and testicular cancer laterality.

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Data availability

Data available upon request.

Abbreviations

CI:

Confidence intervals

hCG:

Human chorionic gonadotropin

HIV:

Human immunodeficiency virus

ICD:

International Classification of Diseases

MeSH:

Medical Subject Headings

NOS:

Newcastle Ottawa Scale

OR:

Odds ratio

RR:

Risk ratio

SD:

Standard deviation

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Author information

Author notes

  1. Christos Kaselas and Evangelia E. Ntzani equally contributed to this work.

Authors and Affiliations

  1. Second Paediatric Surgery Department, Aristotle University of Thessaloniki, “Papageorgiou” General Hospital, Thessaloniki, Greece

    Maria Florou, Ioannis Spyridakis & Christos Kaselas

  2. Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, 45110, Ioannina, Greece

    Konstantinos K. Tsilidis

  3. Pediatric Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece

    Ekaterini Siomou

  4. Department of Pathology, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece

    Triantafyllia Koletsa & Antonia Syrnioti

  5. Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, 45110, Ioannina, Greece

    Evangelia E. Ntzani

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  1. Maria Florou
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Contributions

Study concept and design: Maria Florou, Evangelia Ntzani, Christos Kaselas. Acquisition of data: Maria Florou, Christos Kaselas. Analysis and interpretation of data: Maria Florou, Evangelia Ntzani, Ekaterini Siomou, Triantafyllia Koletsa. Drafting of the manuscript: Maria Florou. Statistical analysis: Maria Florou, Konstantinos Tsilidis, Evangelia Ntzani. Prepared figures and tables: Ekaterini Siomou, Ioannis Spyridakis, Antonia Syrnioti. All authors reviewed the manuscript. Supervision: Christos Kaselas, Evangelia Ntzani.

Corresponding author

Correspondence to Maria Florou.

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This is a systematic review and meta-analysis of observational studies. No ethics approval is required.

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Communicated by Gregorio Milani.

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Florou, M., Tsilidis, K.K., Siomou, E. et al. Orchidopexy for congenital cryptorchidism in childhood and adolescence and testicular cancer in adults: an updated systematic review and meta-analysis of observational studies. Eur J Pediatr 182, 2499–2507 (2023). https://doi.org/10.1007/s00431-023-04947-9

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