title: Patterns of outcome and prognostic factors in primary large-cell lymphoma of the testis in a survey by the International Extranodal Lymphoma Study Group.
abstract: OBJECTIVE
  To determine clinical features and patterns of outcome of primary testicular diffuse large B-cell lymphomas (DLCL).
  
  
  METHODS
  A retrospective international survey of 373 patients with primary testicular DLCL.
  
  
  RESULTS
  Most patients presented with localized disease (stage I to II), and the median age at diagnosis was 66 years (range, 19 to 91 years). Anthracycline-based chemotherapy was administered to 255 patients (68%), and prophylactic intrathecal chemotherapy was given to 68 patients (18%); 133 patients (36%) received prophylactic scrotal radiotherapy. Median overall survival was 4.8 years, and median progression-free survival was 4 years. The survival curves showed no clear evidence of a substantial proportion of cured patients. A favorable international prognostic index score (IPI), no B-symptoms, the use of anthracyclines, and prophylactic scrotal radiotherapy were significantly associated with longer survival at multivariate analysis. However, even for patients with stage I disease and good-risk IPI, the outcome seems worse than what was reported for DLCL at other sites. At a median follow-up of 7.6 years, 195 patients (52%) had relapsed. Extranodal recurrence was reported in 140 cases. Relapses in CNS were detected in 56 patients (15%) up to 10 years after presentation. A continuous risk of recurrence in the contralateral testis was seen in patients not receiving scrotal radiotherapy.
  
  
  CONCLUSIONS
  Testicular DLCL is characterized by a particularly high risk of extranodal relapse even in cases with localized disease at diagnosis. Anthracycline-based chemotherapy, CNS prophylaxis, and contralateral testicular irradiation seem to improve the outcome. Their efficacy is under evaluation in a prospective clinical trial.
authors.affiliation: Division of Haematology/Medical Oncology, Peter MacCallum Cancer Institute, East Melbourne, Australia. ielsg@ticino.com
authors.forename: E
authors.initials: E
authors.lastname: Zucca
authors.forename: A
authors.initials: A
authors.lastname: Conconi
authors.forename: T I
authors.initials: TI
authors.lastname: Mughal
authors.forename: A H
authors.initials: AH
authors.lastname: Sarris
authors.forename: J F
authors.initials: JF
authors.lastname: Seymour
authors.forename: U
authors.initials: U
authors.lastname: Vitolo
authors.forename: R
authors.initials: R
authors.lastname: Klasa
authors.forename: M
authors.initials: M
authors.lastname: Ozsahin
authors.forename: G M
authors.initials: GM
authors.lastname: Mead
authors.forename: M A
authors.initials: MA
authors.lastname: Gianni
authors.forename: S
authors.initials: S
authors.lastname: Cortelazzo
authors.forename: A J M
authors.initials: AJ
authors.lastname: Ferreri
authors.forename: A
authors.initials: A
authors.lastname: Ambrosetti
authors.forename: M
authors.initials: M
authors.lastname: Martelli
authors.forename: C
authors.initials: C
authors.lastname: Thiéblemont
authors.forename: H Gomez
authors.initials: HG
authors.lastname: Moreno
authors.forename: G
authors.initials: G
authors.lastname: Pinotti
authors.forename: G
authors.initials: G
authors.lastname: Martinelli
authors.forename: R
authors.initials: R
authors.lastname: Mozzana
authors.forename: S
authors.initials: S
authors.lastname: Grisanti
authors.forename: M
authors.initials: M
authors.lastname: Provencio
authors.forename: M
authors.initials: M
authors.lastname: Balzarotti
authors.forename: F
authors.initials: F
authors.lastname: Laveder
authors.forename: G
authors.initials: G
authors.lastname: Oltean
authors.forename: V
authors.initials: V
authors.lastname: Callea
authors.forename: P
authors.initials: P
authors.lastname: Roy
authors.forename: F
authors.initials: F
authors.lastname: Cavalli
authors.forename: M K
authors.initials: MK
authors.lastname: Gospodarowicz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D018572:Disease-Free Survival; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome