Probability of metachronous testicular cancer in patients with biopsy-proven intratubular germ cell neoplasia depends on first-time treatment of germ cell cancer.
OBJECTIVE
To evaluate the probability of subsequent testicular cancer (STC) in patients with intratubular germ cell neoplasia unclassified (IGCNU) treated for first-time invasive germ cell cancer.


METHODS
Sixty-one patients with germ cell testicular cancer or extragonadal germ cell cancer received follow-up from diagnosis of IGCNU to development of STC, initiation of IGCNU-definitive treatment (orchiectomy/radiotherapy), emigration, death, or end of follow-up. The probability of STC was assessed in subgroups according to chemotherapy burden.


RESULTS
The probability of STC in the nonexposed patients was significantly increased compared with those exposed to chemotherapy (P = .05; 5-year probability of 54% [95% CI, 33% to 78%] and 23% [95% CI, 11% to 45%], respectively). In the group of patients treated with one to three cycles or no chemotherapy, the probability of STC was significantly increased compared with those exposed to four or more cycles (P = .03; 5-year probability of 42% [95% CI, 27% to 62%] and 22% [95% CI, 8% to 54%], respectively). Twenty-two of 22 patients were tumor-free and alive at a median of 56 months (range, 2 to 184 months) after diagnosis of STC.


CONCLUSIONS
Platinum-based chemotherapy may reduce the probability of STC in patients with IGCNU, particularly in those treated with four or more cycles of chemotherapy. A watch-and-wait strategy for patients with IGCNU may be justified in selected patients with future plans for paternity.
Oslo Universitetssykehus HF, Radiumhospitalet, Postboks 4953 Nydalen, 0424 Oslo, Norway. sigmund.brabrand@medisin.uio.no
Sigmund
S
Brabrand
Sophie D
SD
Fosså
Milada
M
Cvancarova
Ulrika
U
Axcrona
Gustav
G
Lehne
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001706:Biopsy; D001761:Bleomycin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D018237:Germinoma / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control* / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D009664:Norway / Q000453:epidemiology; D009919:Orchiectomy; D017671:Platinum Compounds / Q000008:administration & dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012306:Risk; D013736:Testicular Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control* / Q000532:radiotherapy / Q000601:surgery; D057832:Watchful Waiting
D017671:Platinum Compounds; D001761:Bleomycin; D005047:Etoposide; D002945:Cisplatin