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When is a Seminoma not a Seminoma? The Incidence, Risk Factors and Management of Patients With Testicular Seminoma With Discordant Elevated Serum Alpha-fetoprotein.
- Source :
-
Urology [Urology] 2021 Nov; Vol. 157, pp. 188-196. Date of Electronic Publication: 2021 Aug 11. - Publication Year :
- 2021
-
Abstract
- Objective: To describe the incidence, clinical and demographic factors, and treatment patterns associated with discordant elevated alpha-fetoprotein (AFP) findings in patients with pure seminomatous histology.<br />Methods: We queried the National Cancer Database to identify patients with testicular germ cell tumors (GCT) diagnosed in 2011-2015. Patients were grouped based on histologic diagnosis and pre-operative serum AFP level.<br />Results: Of 18,616 patients diagnosed with testicular GCT, 53% (N = 9,849) had pure seminomatous histology, of whom 8.3% (N = 821) had an elevated serum AFP pre-operatively. Non-white patients with seminoma were more likely to have a pre-op elevated AFP (OR 1.42; 95% CI: 1.10-1.83); patients treated at higher volume centers were less likely to have a pre-op elevated AFP (0.66, 95% CI: 0.53-0.83). Patients with seminoma with elevated AFP received adjuvant radiation more frequently than those with NSGCT (Stage I: 15% vs 0.2%, P <.01; Stage II: 21.9% vs 0.1%, P <.01) and less frequently underwent retroperitoneal lymph node dissection (RPLND) (Stage 1: 1.9% vs 11.1% P <.01; Stage II: 8.8% vs 17.4%, P <.01).<br />Conclusion: The detection of elevated serum alpha-fetoprotein (AFP) in patients with pure seminomatous testicular germ cell tumors (GCT) is a discordant finding that implies the presence of occult non-seminomatous GCT (NSGCT) elements. 8% of patients with pure seminomatous GCTs had diagnostically discordant elevated pre-operative AFP levels. Despite recommendations to manage these patients as NSGCT, patients with seminoma and elevated AFP were managed in a fashion comparable to those with seminoma and normal AFP levels.<br /> (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Chemotherapy, Adjuvant statistics & numerical data
Databases, Factual
Hospitals, High-Volume
Humans
Lymph Node Excision statistics & numerical data
Male
Neoplasm Staging
Orchiectomy statistics & numerical data
Preoperative Period
Proportional Hazards Models
Race Factors
Radiotherapy, Adjuvant statistics & numerical data
Retrospective Studies
Seminoma therapy
Survival Rate
Testicular Neoplasms therapy
United States
Seminoma blood
Seminoma pathology
Testicular Neoplasms blood
Testicular Neoplasms pathology
alpha-Fetoproteins metabolism
Subjects
Details
- Language :
- English
- ISSN :
- 1527-9995
- Volume :
- 157
- Database :
- MEDLINE
- Journal :
- Urology
- Publication Type :
- Academic Journal
- Accession number :
- 34389428
- Full Text :
- https://doi.org/10.1016/j.urology.2021.05.101