Objective
To characterize the incidence, presentation, management, and relapse of a large population
of bilateral testicular germ cell tumors (TGCT) from a single institution.
Patients and Methods
We identified bilateral TGCT diagnosed between January 1989 and February 2014. We
categorized synchronous and metachronous TGCT, noting time between first and second
TGCT, histology (seminoma vs nonseminoma [NSGCT]), stage, and treatments. Kaplan-Meier
survival estimates characterized relapse.
Results
Of 5132 patients with TGCT, 128 (2.5%) had bilateral TGCT. Bilateral TGCT increased
over time—1.7% in 1989-1994 up to 3.8% in 2010 to February 2014. The 35 (27%) synchronous
cases of TGCT had 20 (57%) concordant seminoma, 5 (14%) concordant NSGCT, and 10 (29%)
discordant NSGCT. The 93 (73%) metachronous cases had median time interval to second
TGCT of 73 months (range: 5 months-28.6 years). Compared with first TGCT, 39 (42%)
had discordant histology, 29 (31%) had concordant seminoma, and 25 (27%) had concordant
NSGCT. Stage at first tumor was statistically similar to second TGCT (second stage
I, II, II in 69%, 22%, 10%). Increasing duration between first and second TGCT was
not associated with higher stage (II or III) at second TGCT (P = .09). Treatment at first tumor was not associated with stage at second tumor. Relapse
following bilateral diagnosis was 16.8% (95% confidence interval 10.5%-26.2%) at 5
years.
Conclusion
Incidence of bilateral TGCT increased with >25% of metachronous TGCT presenting ≥10
years after first TGCT; possible causes include increased survivorship and referral
bias. Stage was statistically similar at first and second tumor; stage at second tumor
was not associated with time interval between tumors or prior treatment modality at
first tumor.
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Article info
Publication history
Published online: November 02, 2016
Accepted:
October 13,
2016
Received:
July 13,
2016
Footnotes
Following completion of this manuscript, author affiliations have changed for the following:
Ryan P. Kopp's affiliation has changed to Oregon Health & Science University and VA Portland Healthcare System, Portland, OR.
Michael Chevinsky's affiliation has changed to Washington University, St. Louis, MO.
Financial Disclosure: The authors declare that they have no relevant financial interests.
Funding Support: This study was supported by the Capri Foundation and Sidney Kimmel Center for Prostate and Urologic Cancers.
Identification
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Published by Elsevier Inc.
