Contemporary Trends in Presentation and Management of Spermatocytic Seminoma. Journal Article

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Authors: Patel, PM; Patel, HD; Koehne, EL; Doshi, C; Belshoff, A; Seffren, CM; Baker, M; Gorbonos, A; Gupta, G
Article Title: Contemporary Trends in Presentation and Management of Spermatocytic Seminoma.
Abstract: OBJECTIVE: To characterize the presentation and management of Spermatocytic seminoma (SS) compared to classic seminoma in adults utilizing a large cancer registry. METHODS: Patients >18 years of age in the National Cancer Database from 2006 to 2016 who underwent orchiectomy for testicular tumors were identified. Demographics, oncologic characteristics, and treatment patterns were compared between patients with SS and classic seminoma. RESULTS: Of 53,481 adults receiving orchiectomy, 29,208 were diagnosed with classic seminoma and 299 (1%) with SS. Compared to patients with classic seminoma, SS patients were older (57 vs. 39 years) and more likely to be African-American (OR 1.8) and insured by Medicare (OR 2.0) (all p0.05). SS patients had larger tumors on presentation (3-6 cm: OR 1.8; >6 cm: OR 1.8), but were less likely to have =pT2 stage (OR 0.5), regional nodal involvement (Clinical Stage II: OR 0.3), or distant metastatic disease (Clinical Stage III: OR 0.1) (all p0.01). For post-orchiectomy management, 73.6% of SS patients underwent surveillance while 24.5% had active treatment (RPLND, chemotherapy, radiation, or a combination). When stratified by year, there was an increasing trend toward surveillance compared to active treatment. CONCLUSIONS: SS is a rare germ cell tumor that typically presents as a larger tumor in older patients. Although these tumors are less likely to be characterized by advanced disease compared to classic seminoma, many patients have undergone aggressive post-orchiectomy treatment in the past. Importantly, treatment trends have shifted toward surveillance in recent years with adjuvant therapy limited primarily to higher stage tumors.
Journal Title: Urology
ISSN: 1527-9995; 0090-4295
Publisher: Elsevier Inc  
Date Published: 2020