Organ-Sparing Surgery in Testicular Tumor: Is This the Right Approach for Lesions ≤ 20 mm?
Abstract
:1. Introduction
2. Experimental Section
2.1. Study Design and Case Selection
2.2. Preoperative Examinations and Follow-Up
2.3. Surgical Approach of OSS
2.4. Outcome Measures
2.5. Data Analysis
3. Results
3.1. Baseline Characteristics
3.2. Surgical Outcomes
3.3. Tumor Size as Predictive Marker
3.4. Final Histopathological Findings
4. Discussion
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
Abbreviations
AFP | alpha-fetoprotein |
AUC | area under the curve |
CT | computed tomography |
EAU | European Association of Urology |
FSE | frozen section examination |
GCNIS | germ cell neoplasia in situ |
β-HCG | beta-human chorionic gonadotropin |
IQR | interquartile ranges |
IV | intravenous |
LDH | lactate dehydrogenase |
NPV | negative predictive values |
OSS | organ-sparing surgery |
PPV | positive predictive values |
ROC | receiver operating characteristic |
US | ultrasonography |
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All Tumors | Benign Tumors | Malignant Tumors | p-Value | ||||
---|---|---|---|---|---|---|---|
Value | %, SD, IQR | Value | %, SD, IQR | Value | %, SD, IQR | ||
Number of patients (n) | 89 | 60 | 29 | 0.581 (exact) | |||
Unilaterally treated (n) | 79 | 88.8% | 53 | 88.3% | 26 | 89.7% | |
Bilaterally treated (n) | 10 | 11.2% | 7 | 11.7% | 3 | 10.3% | |
Age (years) | 0.026 | ||||||
Available (n) | 89 | 100% | 60 | 100% | 29 | 100% | |
Mean ± SD (years) | 38.4 | ±16.2 | 41.1 | ±16.8 | 32.9 | ±13.5 | |
Duration of surgery (min) | 0.674 | ||||||
Available (n) | 52 | 58.4% | 40 | 66.7% | 12 | 41.4% | |
Mean ± SD (months) | 61.6 | ±20.2 | 62.3 | ±20.7 | 59.4 | ±19.2 | |
Follow-up (months) | 0.017 | ||||||
Available (n) | 89 | 100% | 60 | 100% | 29 | 100% | |
Median (IQR) (months) | 42 | (3.5–75.5) | 32.5 | (1.3–64.8) | 59 | (29.5–100) |
All Tumors | Benign Tumors | Malignant Tumors | p-Value | ||||
---|---|---|---|---|---|---|---|
Value | %, IQR | Value | %, IQR | Value | %, IQR | ||
Number of treatments (n) | 99 | 67 | 32 | ||||
Ultrasonographic size (mm) | <0.001 | ||||||
Available (n) | 99 | 100% | 67 | 100% | 32 | 100% | |
Median (IQR) (mm) | 10 | (6.0–15.0) | 8.0 | (5–10.0) | 14 | (8.3–17.5) | |
Histopathological size (mm) | 0.018 | ||||||
Available (n) | 85 | 85.9% | 56 | 56.6% | 29 | 90.6% | |
Median (IQR) (mm) | 10 | (6.0–13.0) | 8.0 | (5.3–10.0) | 10.0 | (8.0–15.0) | |
Palpation (n) | 0.138 | ||||||
Available (n) | 87 | 87.9% | 60 | 89.6% | 27 | 84.4% | |
Positive (n) | 26 | 29.9% | 15 | 25.0% | 11 | 40.7% | |
Ischemia (n) | 0.461 (exact) | ||||||
Available (n) | 97 | 98.0% | 66 | 98.5% | 31 | 96.9% | |
Yes (n) | 9 | 9.3% | 5 | 7.6% | 4 | 12.9% | |
Clinical presentation (n) | 0.001 (exact) | ||||||
Available (n) | 82 | 82.8% | 57 | 85.1% | 25 | 78.1% | |
Lump/swelling (n) | 23 | 28.0% | 16 | 28.1% | 7 | 28.0% | |
Pain (n) | 11 | 13.4% | 7 | 12.3% | 4 | 16.0% | |
Incidental (n) | 31 | 37.8% | 23 | 40.4% | 8 | 32.0% | |
Inf/hyp/gyn 1 (n) | 11 | 13.4% | 11 | 19.3% | 0 | 0% | |
Oncologic follow-up (n) | 6 | 7.3% | 0 | 0% | 6 | 24.0% |
Tumor Size (mm) | Overall (n = 99) | Benign (n = 67) | Malignant (n = 32) |
---|---|---|---|
≤5 mm, n (%) | 21 | 20 (29.9) | 1 (3.1) |
>5 mm and ≤10 mm, n (%) | 34 | 23 (34.3) | 11 (34.4) |
>10 mm and ≤15 mm, n (%) | 26 | 17 (25.4) | 9 (28.1) |
>15 mm and ≤20 mm, n (%) | 18 | 7 (10.4) | 11 (34.4) |
Malignant and Benign Lesions | n | % |
---|---|---|
Seminomatous germ-cell tumor | 22 | 22.2 |
Nonseminomatous: pure teratoma | 8 | 8.1 |
Nonseminomatous: mixed germ cell 1 | 2 | 2.0 |
Leydig cell tumor or hyperplasia | 32 | 32.3 |
Sertoli cell tumor | 4 | 4.0 |
Fibrotic pseudotumor | 10 | 10.1 |
Adenomatoid tumor | 2 | 2.0 |
Dermoid cyst | 10 | 10.1 |
Cystic lesion | 3 | 3.0 |
Hemangioma | 4 | 4.0 |
Splenogonadal fusion | 1 | 1.0 |
Leiomyoma | 1 | 1.0 |
Total | 99 | 100 |
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Staudacher, N.; Tulchiner, G.; Bates, K.; Ladurner, M.; Kafka, M.; Aigner, F.; Pichler, R.; Horninger, W. Organ-Sparing Surgery in Testicular Tumor: Is This the Right Approach for Lesions ≤ 20 mm? J. Clin. Med. 2020, 9, 2911. https://doi.org/10.3390/jcm9092911
Staudacher N, Tulchiner G, Bates K, Ladurner M, Kafka M, Aigner F, Pichler R, Horninger W. Organ-Sparing Surgery in Testicular Tumor: Is This the Right Approach for Lesions ≤ 20 mm? Journal of Clinical Medicine. 2020; 9(9):2911. https://doi.org/10.3390/jcm9092911
Chicago/Turabian StyleStaudacher, Nina, Gennadi Tulchiner, Katie Bates, Michael Ladurner, Mona Kafka, Friedrich Aigner, Renate Pichler, and Wolfgang Horninger. 2020. "Organ-Sparing Surgery in Testicular Tumor: Is This the Right Approach for Lesions ≤ 20 mm?" Journal of Clinical Medicine 9, no. 9: 2911. https://doi.org/10.3390/jcm9092911