Fifteen Years of Experience in the Management of Non-Seminomatous Testicular Germ Cell Tumors at a Tertiary Care Center in Pakistan

Mutahir A. Tunio, Altaf Hashmi, Najib Naimatullah, Rehan Mohsin, Syed Amir Maqbool, Mansoor Rafi


Objective: We evaluated the treatment outcome and associated prognostic factors for patients with nonseminomatous testicular germ cell tumours (NSGCT), who were treated in our hospital during last 15 years.
Methodology: Data was retrospectively analyzed for the 1995 through 2010 period. One hundred and twenty patients with NSGCT were identified. Descriptive Data was analyzed for the age, risk factors, site, histology, stage, chemotherapy regimen, retroperitoneal lymph node dissection (RPLND) and radiological response. The disease free survival (DFS) and overall survival (OS) were determined by Kaplan and Meier method and statistical inferences with the log-rank test. Cox proportional hazards Model was used to find different prognostic factors.
Results: Mean age of patients was 29.65 years (16-45). Pain and swelling of testis was commonest presentation (30%). Right sided were predominant (63.3%). Predominant stage was IIIC (55%) and commonest histology was mixed (embryonal cell carcinoma+yolk sac tumor+teratoma) in 45% cases. Majority of patients were poor risk according to International Germ Cell Cancer Consensus Classification (IGCCC), 41.7%. Bleomycin, etoposide and cisplatinum (BEP) chemotherapy was mostly as a first line treatment (87.5%). Postchemotherapy RPLND was performed in 31 patients (25.8%). Histology among residuals was fibrosis (48.4%), viable tumors (35.5%) and mature teratoma (16.1%). Median DFS and OS were 9 and 9.1 years respectively. Stage, IGCCC, RPLND were found important prognostic factors (p < 0.001).
Conclusion: Better outcome with lower disease burden and lower IGCCC and multidiscplinary approach warrants public awareness should be carried out for the testicular self-examination to reduce the time from the beginning of symptoms to time of seeking treatment.

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