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Freddie Bray - One of the best experts on this subject based on the ideXlab platform.
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Testicular Cancer incidence predictions in Europe 2010-2035: A rising burden despite population ageing.
2019Co-Authors: Ariana Znaor, Niels E Skakkebaek, Katherine A Mcglynn, Ewa Rajpert-de Meyts, Mathieu Laversanne, T. Kulis, Jason Gurney, Diana Sarfati, Freddie BrayAbstract:Testicular Cancer is the most common Cancer among young men of European ancestry, with about one-third of all cases occurring in Europe. With the historically increasing trends in some high-incidence populations reported to have stabilised in recent years, we aimed to assess recent trends and predict the future Testicular Cancer incidence burden across Europe. We extracted Testicular Cancer (ICD-10 C62) incidence data from Cancer Incidence in Five Continents Volumes VII-XI and complemented this with data published by registries from 28 European countries. We predicted Cancer incidence rates and the number of incident cases in Europe in the year 2035 using the NORDPRED age-period-cohort model. Testicular Cancer incidence rates will increase in 21 out of 28 countries over the period 2010-2035, with trends attenuating in the high-incidence populations of Denmark, Norway, Switzerland and Austria. Although population ageing would be expected to reduce the number of cases, this demographic effect is outweighed by increasing risk, leading to an overall increase in the number of cases by 2035 in Europe, and by region (21, 13 and 32% in Northern, Western and Eastern Europe, respectively). Declines are however predicted in Italy and Spain, amounting to 12% less cases in 2035 in Southern Europe overall. In conclusion, the burden of Testicular Cancer incidence in Europe will continue to increase, particularly in historically lower-risk countries. The largest increase in the number of Testicular Cancer patients is predicted in Eastern Europe, where survival is lower, reinforcing the need to ensure the provision of effective treatment across Europe.
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international Testicular Cancer incidence trends generational transitions in 38 countries 1900 1990
2015Co-Authors: Ariana Znaor, Mathieu Laversanne, Joannie Lortettieulent, Ahmedin Jemal, Freddie BrayAbstract:Purpose Rapid increases in Testicular Cancer incidence have marked the second half of the last century. While these secular rises, observed mainly in countries attaining the highest levels of human development, appear to have attenuated in the last decade, rates continue to increase in countries transiting toward high developmental levels. The purpose of our study was to provide a comprehensive analysis and presentation of the cohort-specific trends in Testicular Cancer incidence rates in 38 countries worldwide.
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international patterns and trends in Testicular Cancer incidence overall and by histologic subtype 1973 2007
2015Co-Authors: Britton Trabert, Susan S Devesa, Freddie Bray, Jie Chen, Katherine A McglynnAbstract:Background Incidence rates of Testicular Cancer in Northern European and North American countries have been widely reported, whereas rates in other populations, such as Eastern Europe, Central/South America, Asia, and Africa, have been less frequently evaluated. We examined Testicular Cancer incidence rates overall and by histologic type by calendar time and birth cohort for selected global populations 1973-2007.
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international variations and trends in Testicular Cancer incidence and mortality
2014Co-Authors: Ariana Znaor, Joannie Lortettieulent, Ahmedin Jemal, Freddie BrayAbstract:Abstract Context Testicular Cancer (TC) is the most common Cancer in men aged 15–44 yr in many countries that score high or very high on the Human Development Index (HDI). Despite the very good prognosis for TC, wide variations in mortality rates have been reported internationally. Objective To describe and contrast global variations and recent trends in TC incidence and mortality rates. Evidence acquisition To compare TC incidence and mortality rates, we used GLOBOCAN 2008 estimates. We used the Cancer Incidence in Five Continents series to analyse recent trends in TC incidence in 41 countries by way of joinpoint analysis. To examine recent trends in mortality, we used the World Health Organisation mortality database. Evidence synthesis Northern Europe remains the highest TC incidence area, with the highest rates observed in Norway and Denmark. Incidence rates continue to increase in most countries worldwide, more markedly in Southern Europe and Latin America, while attenuating in Northern Europe, the United States, and Australia. Mortality from TC shows a different pattern, with higher rates in some countries of medium to high HDI. The highest mortality rates were seen in Chile and Latvia, as well as in selected Central European and Eastern European countries. In high-income countries, TC mortality rates are declining or stable at very low levels of magnitude, while no significant decreases were observed in middle-income regions in Latin America and Asia. Conclusions The rises in TC incidence appear to be recently attenuating in countries with the highest HDIs, with corresponding mortality rates either continuing to decline or stabilising at very low levels. In a number of countries transiting towards higher levels of development, the TC incidence is increasing while mortality rates are stable or increasing. Patient summary In this study we looked at international Testicular Cancer trends. We found that Testicular Cancer is becoming more common in low- and middle-income countries, where the optimal treatment might not yet be available.
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Testicular Cancer incidence to rise by 25 by 2025 in europe model based predictions in 40 countries using population based registry data
2014Co-Authors: Charlotte Le Cornet, Joannie Lortettieulent, David Forman, Remi Beranger, Aude Flechon, B Fervers, Joachim Schuz, Freddie BrayAbstract:Abstract Background Testicular Cancer mainly affects White Caucasian populations, accounts for 1% of all male Cancers, and is frequently the most common malignancy among young adult men. In light of the escalating rates of Testicular Cancer incidence in Europe, and in support of future planning to ensure optimal care of patients with what can be a curable disease, we predict the future burden in 40 European countries around 2025. Methods Current observed trends were extrapolated with the NORDPRED model to estimate the future burden of Testicular Cancer in the context of changes in risk versus changes in demographics. Findings Despite substantial heterogeneity in the rates, the vast majority of European countries will see an increasing burden over the next two decades. We estimate there will be 23,000 new cases of Testicular Cancer annually in Europe by 2025, a rise of 24% from 2005. Some of the most rapid increases in Testicular Cancer are observed in Croatia, Slovenia, Italy and Spain, and a transition is underway, whereby recent attenuations and declines in rates in certain high-risk countries in Northern Europe contrast with the increasing trends and escalating burden in Southern Europe. According to our estimates for 2025, around one in 100 men will be diagnosed with the disease annually in the highest risk countries of Europe (Croatia, Slovenia and Norway). Interpretation Elucidating the key determinants of Testicular Cancer and the equitable provision of optimal care for patients across Europe are priorities given the steady rise in the number of patients by 2025, and an absence of primary prevention opportunities. Funding None.
Lois B Travis - One of the best experts on this subject based on the ideXlab platform.
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Testicular Cancer survivorship: Research strategies and recommendations
2010Co-Authors: Lois B Travis, Clair Beard, Jennifer L. Kelly, Jeroen Oldenburg, Alv A. Dahl, Gedske Daugaard, M. Eileen Dolan, Darren R. Feldman, James M. Allan, Robyn HanniganAbstract:Testicular Cancer represents the most curable solid tumor, with a 10-year survival rate of more than 95%. Given the young average age at diagnosis, it is estimated that effective treatment approaches, in particular, platinum-based chemotherapy, have resulted in an average gain of several decades of life. This success, however, is offset by the emergence of considerable long-term morbidity, including second malignant neoplasms, cardiovascular disease, neurotoxicity, nephrotoxicity, pulmonary toxicity, hypogonadism, decreased fertility, and psychosocial problems. Data on underlying genetic or molecular factors that might identify those patients at highest risk for late sequelae are sparse. Genome-wide association studies and other translational molecular approaches now provide opportunities to identify Testicular Cancer survivors at greatest risk for therapy-related complications to develop evidence-based long-term follow-up guidelines and interventional strategies. We review research priorities identified during an international workshop devoted to Testicular Cancer survivors. Recommendations include 1) institution of lifelong follow-up of Testicular Cancer survivors within a large cohort setting to ascertain risks of emerging toxicities and the evolution of known late sequelae, 2) development of comprehensive risk prediction models that include treatment factors and genetic modifiers of late sequelae, 3) elucidation of the effect(s) of decades-long exposure to low serum levels of platinum, 4) assessment of the overall burden of medical and psychosocial morbidity, and 5) the eventual formulation of evidence-based long-term follow-up guidelines and interventions. Just as Testicular Cancer once served as the paradigm of a curable malignancy, comprehensive follow-up studies of Testicular Cancer survivors can pioneer new methodologies in survivorship research for all adult-onset Cancer.
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second Cancers among 40 576 Testicular Cancer patients focus on long term survivors
2005Co-Authors: Lois B Travis, Eric Holowaty, Sophie D. Fosså, Aage Andersen, Per Hall, Sara J Schonfeld, Mary L Mcmaster, Charles F Lynch, Hans H Storm, Eero PukkalaAbstract:Background: Although second primary Cancers are a leading cause of death among men with Testicular Cancer, few studies have quantifi ed risks among long-term survivors. Methods: Within 14 population-based tumor registries in Europe and North America (1943–2001), we identifi ed 40 576 1-year survivors of Testicular Cancer and ascertained data on any new incident solid tumors among these patients. We used Poisson regression analysis to model relative risks (RRs) and excess absolute risks (EARs) of second solid Cancers. All statistical tests were two-sided. Results: A total of 2285 second solid Cancers were reported in the cohort. The relative risk and EAR decreased with increasing age at Testicular Cancer diagnosis ( P <.001); the EAR increased with attained age ( P <.001) but the excess RR decreased. Among 10-year survivors diagnosed with Testicular Cancer at age 35 years, the risk of developing a second solid tumor was increased (RR = 1.9, 95% confi dence interval [CI] = 1.8 to 2.1). Risk remained statistically signifi cantly elevated for 35 years (RR = 1.7, 95% CI = 1.5 to 2.0; P <.001). We observed statistically signifi cantly elevated risks, for the fi rst time, for Cancers of the pleura (malignant mesothelioma; RR = 3.4, 95% CI = 1.7 to 5.9) and esophagus (RR = 1.7, 95% CI = 1.0 to 2.6). Cancers of the lung (RR = 1.5, 95% CI = 1.2 to 1.7), colon (RR = 2.0, 95% CI = 1.7 to 2.5), bladder (RR = 2.7, 95% CI = 2.2 to 3.1), pancreas (RR = 3.6, 95% CI = 2.8 to 4.6), and stomach (RR = 4.0, 95% CI = 3.2 to 4.8) accounted for almost 60% of the total excess. Overall patterns were similar for seminoma and nonseminoma patients, with lower risks observed for nonseminoma patients treated after 1975. Statistically signifi cantly increased risks of solid Cancers were observed among patients treated with radiotherapy alone (RR = 2.0, 95% CI = 1.9 to 2.2), chemotherapy alone (RR = 1.8, 95% CI = 1.3 to 2.5), and both (RR = 2.9, 95% CI = 1.9 to 4.2). For patients diagnosed with seminomas or nonseminomatous tumors at age 35 years, cumulative risks of solid Cancer 40 years later (i.e., to age 75 years) were 36% and 31%, respectively, compared with 23% for the general population. Conclusions : Testicular Cancer survivors are at statistically signifi cantly increased risk of solid tumors for at least 35 years after treatment. Young patients may experience high levels of risk as they reach older ages. The statistically signifi cantly increased risk of malignant mesothelioma in Testicular Cancer survivors has, to our knowledge, not been observed previously in a cohort of patients treated with radiotherapy. [J Natl Cancer Inst 2005;97:1354–65]
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risk of contralateral Testicular Cancer a population based study of 29 515 u s men
2005Co-Authors: Sophie D. Fosså, Jinbo Chen, Katherine A Mcglynn, Sara J Schonfeld, Mary L Mcmaster, Mitchell H Gail, Lois B TravisAbstract:Background: Although risk estimates for synchronous and metachronous contralateral Testicular Cancers vary widely, many clinicians recommend routine biopsy of the contralateral testis for patients diagnosed with unilateral Testicular Cancer. We evaluated the risk of contralateral Testicular Cancer and survival in a large population-based cohort of men diagnosed with Testicular Cancer before age 55 years. Methods: For 29 515 Testicular Cancer cases reported to the National Cancer Institute’s Surveillance, Epidemiology and End Results Program from 1973 through 2001, we estimated the prevalence of synchronous contralateral Testicular Cancer, the observed-to-expected ratio (O/E) and 15-year cumulative risk of metachronous contralateral Testicular Cancer, and the 10-year overall survival rate of both synchronous and metachronous con tralateral Testicular Cancer, using the Kaplan – Meier method for the two latter assessments. Age-adjusted multivariable analyses were used to examine risk according to histologic type of the original Cancer. Results: A total of 175 men presented with synchronous contralateral Testicular Cancer; 287 men developed metachronous contralateral Testicular Cancer (O/E = 12.4 [95% confi dence interval {CI} = 11.0 to 13.9]; 15-year cumulative risk = 1.9% [95% CI = 1.7% to 2.1%]). In the multivariable analysis, only nonseminomatous histology of the fi rst Testicular Cancer was associated with a statistically signifi cantly decreased risk of metachronous contralateral Testicular Cancer (hazard ratio [HR] = 0.60, 95% confi dence interval [CI] = 0.46 to 0.79; P<.001). Increasing age at fi rst Testicular Cancer diagnosis was associated with decreasing risk of nonseminomatous metachronous con tra lateral Testicular Cancer (odds ratio = 0.90, 95% CI = 0.86 to 0.94). The 10-year overall survival rate after metachronous contralateral Testicular Cancer diagnosis was 93% (95% CI = 88% to 96%), and that after synchronous contralateral Testicular Cancer was 85% (95% CI = 78% to 90%). Conclusions: The
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Risk of second malignant neoplasms among long-term survivors of Testicular Cancer
1997Co-Authors: Lois B Travis, Eric Holowaty, B A Kohler, Flora E Van Leeuwen, Hans Storm, C F Lynch, Rochelle E Curtis, Per Hall, Eero Pukkala, M AnderssonAbstract:BACKGROUND: We have quantified the site-specific risk of second malignant neoplasms among nearly 29,000 survivors (> or = 1 year) of Testicular Cancer, taking into account the histologic type of initial Cancer and the primary therapy used to treat it. METHODS: The study cohort consisted of 28,843 men identified within 16 population-based tumor registries in North America and Europe; over 3300 men had survived more than 20 years. New invasive Cancers were identified through a search of registry files. RESULTS: Second Cancers were reported in 1406 men (observed-to-expected ratio [O/E] = 1.43; 95% confidence interval = 1.36-1.51), with statistically significant excesses noted for acute lymphoblastic leukemia (O/E = 5.20), acute nonlymphocytic leukemia (O/E = 3.07), melanoma (O/E = 1.69), non-Hodgkin's lymphoma (O/E = 1.88), and Cancers of the stomach (O/E = 1.95), colon (O/E = 1.27), rectum (O/E = 1.41), pancreas (O/E = 2.21), prostate (O/E = 1.26), kidney (O/E = 1.50), bladder (O/E = 2.02), thyroid (O/E = 2.92), and connective tissue (O/E = 3.16). Overall risk was similar after seminomas (O/E = 1.42) or nonseminomatous tumors (O/E = 1.50). Risk of solid tumors increased with time since the diagnosis of Testicular Cancer, yielding an O/E = 1.54 (O = 369) among 20-year survivors (two-sided P for trend = .00002). Secondary leukemia was associated with both radiotherapy and chemotherapy, whereas excess Cancers of the stomach, bladder, and, possibly, pancreas were associated mainly with radiotherapy. CONCLUSIONS: Men with Testicular Cancer continue to be at significantly elevated risk of second malignant neoplasms for more than two decades following initial diagnosis. Patterns of excess second Cancers suggest that many factors may be involved, although the precise roles of treatment, natural history, diagnostic surveillance, and other influences are yet to be clarified.
Sophie D. Fosså - One of the best experts on this subject based on the ideXlab platform.
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NonCancer causes of death in survivors of Testicular Cancer
2007Co-Authors: Sophie D. Fosså, Ethel Gilbert, Sara Schonfeld, Eric Holowaty, Hans Storm, Jinbo Chen, Gra̧a M. Dores, Per Hall, Katherine A Mcglynn, Aage AndersenAbstract:BACKGROUND: Although modern treatments for Testicular Cancer are associated with increased survival, the long-term health effects of these treatments are unclear. We conducted a population-based study to quantify the long-term risks of mortality from nonCancer causes among men with Testicular Cancer. METHODS: We identified 38,907 one-year survivors of Testicular Cancer within 14 population-based Cancer registries in North America and Europe (from 1943 through 2002). We used data from these registries to calculate standardized mortality ratios (SMRs) for nonCancer deaths and to evaluate associations between histology, age at Testicular Cancer diagnosis, calendar year of diagnosis, and initial treatment and the risk of nonCancer mortality. All statistical tests were two-sided. RESULTS: A total of 2942 deaths from all nonCancer causes were reported after a median follow-up of 10 years, exceeding the expected number of deaths from all nonCancer causes in the general population by 6% (SMR = 1.06, 95% confidence interval [CI] = 1.02 to 1.10); the nonCancer standardized mortality ratios did not differ statistically significantly between patients diagnosed before and after 1975, when cisplatin-based chemotherapy came into widespread use. Compared with the general population, Testicular Cancer survivors had higher mortality from infections (SMR = 1.28, 95% CI = 1.12 to 1.47) and from digestive diseases (SMR = 1.44, 95% CI = 1.26 to 1.64). Mortality from all circulatory diseases was statistically significantly elevated in men diagnosed with Testicular Cancer before age 35 years (1.23, 95% CI = 1.09 to 1.39) but not in men diagnosed at older ages (SMR = 0.94; 95% CI = 0.89 to 1.00). Men treated with chemotherapy (with or without radiotherapy) in 1975 or later had higher mortality from all nonCancer causes (SMR = 1.34, 95% CI = 1.15 to 1.55), all circulatory diseases (SMR = 1.58, 95% CI = 1.25 to 2.01), all infections (SMR = 2.48, 95% CI = 1.70 to 3.50), and all respiratory diseases (SMR = 2.53, 95% CI = 1.26 to 4.53). Testicular Cancer patients who were younger than 35 years at diagnosis and were treated with radiotherapy alone in 1975 or later had higher mortality from all circulatory diseases (SMR = 1.70, 95% CI = 1.21 to 2.31) compared with the general population. CONCLUSION: Men who have survived for at least 1 year after being diagnosed with Testicular Cancer have a slightly higher risk of dying from nonCancer causes, including infections, digestive diseases, and circulatory diseases, than the general population. Men treated with chemotherapy in 1975 or later may be at particularly high risk.
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paternity following treatment for Testicular Cancer
2005Co-Authors: Marianne Brydoy, Sophie D. Fosså, Olbjorn Klepp, Roy M Bremnes, Erik Wist, Tore Wentzellarsen, Olav DahlAbstract:Background: Studies of fertility in men treated for Testicular Cancer have mainly addressed serum follicle-stimulating hormone levels and sperm parameters. We assessed post-treatment paternity among long-term survivors of Testicular Cancer. Methods: Men (n = 1814) who had been treated for unilateral Testicular Cancer in Norway during 1980 through 1994 were invited to participate in a national multi-center follow-up survey in 1998 through 2002. The participants were allocated to fi ve groups according to the treatment received after orchiectomy, including treatment at relapse (surveillance, retroperitoneal lymph node dissection, radiotherapy, low-dose chemotherapy [i.e., ≤850 mg cisplatin], and high-dose chemotherapy [i.e., >850 mg cisplatin]). Cox proportional hazards analysis was used to assess predictive factors for post-treatment paternity. Statistical tests were two-sided. Results: A total of 1433 men were assessable, of whom 827 were fathers at diagnosis. Posttreatment conception was attempted by 554 men, among whom the overall 15-year actuarial post-treatment paternity rate was 71% (95% confi dence interval [CI] = 66% to 75%) without the use of cryopreserved semen. This rate ranged from 48% (95% CI = 30% to 69%) in the high-dose chemotherapy group to 92% (95% CI = 78% to 98%) in the surveillance group ( P <.001). The median actuarial time from diagnosis to the birth of the fi rst child after treatment was 6.6 years overall but varied according to treatment. Assisted reproductive technologies were used by 22% of the couples who attempted conception after treatment. Dry ejaculation, treatment group, pretreatment fatherhood, and marital status were statistically signifi cant independent predictors for post-treatment fatherhood, with dry ejaculation as the most important negative factor. Conclusions: Although the overall paternity rate after treatment for Testicular Cancer was high, the ability to conceive and the time to conception refl ected the intensity of treatment. These data may help inform patients about their future ability to father biological children. [J Natl Cancer Inst 2005;97:1580 – 8]
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second Cancers among 40 576 Testicular Cancer patients focus on long term survivors
2005Co-Authors: Lois B Travis, Eric Holowaty, Sophie D. Fosså, Aage Andersen, Per Hall, Sara J Schonfeld, Mary L Mcmaster, Charles F Lynch, Hans H Storm, Eero PukkalaAbstract:Background: Although second primary Cancers are a leading cause of death among men with Testicular Cancer, few studies have quantifi ed risks among long-term survivors. Methods: Within 14 population-based tumor registries in Europe and North America (1943–2001), we identifi ed 40 576 1-year survivors of Testicular Cancer and ascertained data on any new incident solid tumors among these patients. We used Poisson regression analysis to model relative risks (RRs) and excess absolute risks (EARs) of second solid Cancers. All statistical tests were two-sided. Results: A total of 2285 second solid Cancers were reported in the cohort. The relative risk and EAR decreased with increasing age at Testicular Cancer diagnosis ( P <.001); the EAR increased with attained age ( P <.001) but the excess RR decreased. Among 10-year survivors diagnosed with Testicular Cancer at age 35 years, the risk of developing a second solid tumor was increased (RR = 1.9, 95% confi dence interval [CI] = 1.8 to 2.1). Risk remained statistically signifi cantly elevated for 35 years (RR = 1.7, 95% CI = 1.5 to 2.0; P <.001). We observed statistically signifi cantly elevated risks, for the fi rst time, for Cancers of the pleura (malignant mesothelioma; RR = 3.4, 95% CI = 1.7 to 5.9) and esophagus (RR = 1.7, 95% CI = 1.0 to 2.6). Cancers of the lung (RR = 1.5, 95% CI = 1.2 to 1.7), colon (RR = 2.0, 95% CI = 1.7 to 2.5), bladder (RR = 2.7, 95% CI = 2.2 to 3.1), pancreas (RR = 3.6, 95% CI = 2.8 to 4.6), and stomach (RR = 4.0, 95% CI = 3.2 to 4.8) accounted for almost 60% of the total excess. Overall patterns were similar for seminoma and nonseminoma patients, with lower risks observed for nonseminoma patients treated after 1975. Statistically signifi cantly increased risks of solid Cancers were observed among patients treated with radiotherapy alone (RR = 2.0, 95% CI = 1.9 to 2.2), chemotherapy alone (RR = 1.8, 95% CI = 1.3 to 2.5), and both (RR = 2.9, 95% CI = 1.9 to 4.2). For patients diagnosed with seminomas or nonseminomatous tumors at age 35 years, cumulative risks of solid Cancer 40 years later (i.e., to age 75 years) were 36% and 31%, respectively, compared with 23% for the general population. Conclusions : Testicular Cancer survivors are at statistically signifi cantly increased risk of solid tumors for at least 35 years after treatment. Young patients may experience high levels of risk as they reach older ages. The statistically signifi cantly increased risk of malignant mesothelioma in Testicular Cancer survivors has, to our knowledge, not been observed previously in a cohort of patients treated with radiotherapy. [J Natl Cancer Inst 2005;97:1354–65]
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risk of contralateral Testicular Cancer a population based study of 29 515 u s men
2005Co-Authors: Sophie D. Fosså, Jinbo Chen, Katherine A Mcglynn, Sara J Schonfeld, Mary L Mcmaster, Mitchell H Gail, Lois B TravisAbstract:Background: Although risk estimates for synchronous and metachronous contralateral Testicular Cancers vary widely, many clinicians recommend routine biopsy of the contralateral testis for patients diagnosed with unilateral Testicular Cancer. We evaluated the risk of contralateral Testicular Cancer and survival in a large population-based cohort of men diagnosed with Testicular Cancer before age 55 years. Methods: For 29 515 Testicular Cancer cases reported to the National Cancer Institute’s Surveillance, Epidemiology and End Results Program from 1973 through 2001, we estimated the prevalence of synchronous contralateral Testicular Cancer, the observed-to-expected ratio (O/E) and 15-year cumulative risk of metachronous contralateral Testicular Cancer, and the 10-year overall survival rate of both synchronous and metachronous con tralateral Testicular Cancer, using the Kaplan – Meier method for the two latter assessments. Age-adjusted multivariable analyses were used to examine risk according to histologic type of the original Cancer. Results: A total of 175 men presented with synchronous contralateral Testicular Cancer; 287 men developed metachronous contralateral Testicular Cancer (O/E = 12.4 [95% confi dence interval {CI} = 11.0 to 13.9]; 15-year cumulative risk = 1.9% [95% CI = 1.7% to 2.1%]). In the multivariable analysis, only nonseminomatous histology of the fi rst Testicular Cancer was associated with a statistically signifi cantly decreased risk of metachronous contralateral Testicular Cancer (hazard ratio [HR] = 0.60, 95% confi dence interval [CI] = 0.46 to 0.79; P<.001). Increasing age at fi rst Testicular Cancer diagnosis was associated with decreasing risk of nonseminomatous metachronous con tra lateral Testicular Cancer (odds ratio = 0.90, 95% CI = 0.86 to 0.94). The 10-year overall survival rate after metachronous contralateral Testicular Cancer diagnosis was 93% (95% CI = 88% to 96%), and that after synchronous contralateral Testicular Cancer was 85% (95% CI = 78% to 90%). Conclusions: The
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incidence of metachronous Testicular Cancer in patients with extragonadal germ cell tumors
2001Co-Authors: Jorg T Hartmann, Sophie D. Fosså, A Horwich, Craig R Nichols, Jean Paul Droz, A Gerl, Jorg Beyer, Jorg Pont, Karim Fizazi, Hartmut HeckerAbstract:Incidence of metachronous Testicular Cancer in patients with extragonadal germ cell tumours. Background: The frequency of subsequent Testicular Cancer (referred to as metachronous Testicular Cancer) in men who have had previous Testicular Cancer is relatively high. The rate of metachronous Testicular Cancer in men with extragonadal germ cell tumors (EGCTs), however, is largely unknown. We conducted a retrospective study of EGCT patients to determine the incidence, cumulative risk, and specific risk factors for metachronous Testicular Cancers. Methods: A standardized questionnaire about patient characteristics, the extent of EGCT disease, any second malignancies, and treatments received was completed for 635 patients with EGCTs identified from the medical records of 11 Cancer centers in Europe and the United States from 1975 through 1996. Comparisons with age group- specific data from the Saarland, Germany, population-based Cancer registry were used to calculate the standardized incidence ratio (SIR). The Kaplan-Meier method was used to analyze survival data and cumulative risk. All statistical tests were two-sided. Results: Sixteen EGCT patients (4.1%) developed metachronous Testicular Cancers, with a median time between diagnoses of 60 months (range, 14-102 months). The risk of developing metachronous Testicular Cancers was statistically significantly increased in patients with EGCTs (observed = 16; expected = 0.26; SIR = 62; 95% confidence interval [CI] = 36 to 99) and in subsets of EGCT patients with mediastinal location (SIR = 31; 95% CI = 8 to 59), retroperitoneal location (SIR = 100; 95% CI = 54 to 172), and nonseminomatous histology (SIR = 75; 95% CI = 43 to 123). The cumulative risk of developing a metachronous Testicular Cancer 10 years after a diagnosis of EGCT was 10.3% (95% CI = 4.9% to 15.6%) and was higher among patients with nonseminomatous EGCTs (14.3%; 95% CI = 6.7% to 21.9%) and retroperitoneal EGCTs (14.2%; 95% CI = 5.6% to 22.8%) than among patients with seminomatous EGCTs (1.4%; 95% CI = 0.0% to 4.2%) and mediastinal EGCTs (6.2%; 95% CI = 0.1% to 12.2%). Conclusions: Patients with EGCTs, particularly those with retroperitoneal or nonseminomatous tumors, but also those with primary mediastinal EGCTs, are at an increased risk of metachronous Testicular Cancer.
A Horwich - One of the best experts on this subject based on the ideXlab platform.
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eau guidelines on Testicular Cancer 2011 update
2012Co-Authors: Peter Albers, A Horwich, Walter Albrecht, Ferran Algaba, Carsten Bokemeyer, Gabriella Cohncedermark, K Fizazi, M P LagunaAbstract:Abstract Context On behalf of the European Association of Urology (EAU), guidelines for the diagnosis, therapy, and follow-up of Testicular Cancer were established. Objective This article is a short version of the EAU Testicular Cancer guidelines and summarises the main conclusions from the guidelines on the management of Testicular Cancer. Evidence acquisition Guidelines were compiled by a multidisciplinary guidelines working group. A systematic review was carried out using Medline and Embase, also taking Cochrane evidence and data from the European Germ Cell Cancer Consensus Group into consideration. A panel of experts weighted the references, and a level of evidence and grade of recommendation were assigned. Results There is a paucity of literature especially regarding longer term follow-up, and results from a number of ongoing trials are awaited. The choice of treatment centre is of the utmost importance, and treatment in reference centres within clinical trials, especially for poor-prognosis nonseminomatous germ cell tumours (NSGCTs), provides better outcomes. For patients with clinical stage I seminoma, based on recently published data on long-term toxicity, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment. The TNM classification 2009 is recommended. Conclusions These guidelines contain information for the standardised management of patients with Testicular Cancer based on the latest scientific insights. Cure rates are generally excellent, but because Testicular Cancer mainly affects men in their third or fourth decade of life, treatment effects on fertility require careful counselling of patients, and treatment must be tailored taking individual circumstances and patient preferences into account. Take home message Although Testicular Cancer has excellent cure rates, the choice of treatment centre is of the utmost importance. Expert centres achieve better results for both early stage Testicular Cancer (lower relapse rates) and overall survival (higher stages within clinical trials). For patients with clinical stage I seminoma, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment.
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eau guidelines on Testicular Cancer 2011 update
2011Co-Authors: Peter Albers, A Horwich, Walter Albrecht, Ferran Algaba, Carsten Bokemeyer, Gabriella Cohncedermark, K Fizazi, M P LagunaAbstract:Context: On behalf of the European Association of Urology (EAU), guidelines for the diagnosis, therapy, and follow-up of Testicular Cancer were established. Objective: This article is a short version of the EAU Testicular Cancer guidelines and summarises the main conclusions from the guidelines on the management of Testicular Cancer. Evidence acquisition: Guidelines were compiled by a multidisciplinary guidelines working group. A systematic review was carried out using Medline and Embase, also taking Cochrane evidence and data from the European Germ Cell Cancer Consensus Group into consideration. A panel of experts weighted the references, and a level of evidence and grade of recommendation were assigned. Results: There is a paucity of literature especially regarding longer term follow-up, and results from a number of ongoing trials are awaited. The choice of treatment centre is of the utmost importance, and treatment in reference centres within clinical trials, especially for poorprognosis nonseminomatous germ cell tumours (NSGCTs), provides better outcomes. For patients with clinical stage I seminoma, based on recently published data on long-term toxicity, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment. The TNM classification 2009 is recommended. Conclusions: These guidelines contain information for the standardised management of patients with Testicular Cancer based on the latest scientific insights. Cure rates are generally excellent,
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guidelines on Testicular Cancer
2005Co-Authors: Peter Albers, A Horwich, Walter Albrecht, Ferran Algaba, Carsten Bokemeyer, Gabriella Cohncedermark, Olbjoern Klepp, Pilar M Laguna, Giorgio PizzocaroAbstract:Abstract Objective To up-date the 2001 version of the EAU Testicular Cancer guidelines. Methods A non-structured literature review until January 2005 using the MEDLINE database has been performed. Literature has been classified according to evidence-based medicine levels. Results Testicular Cancer is a highly curable disease. Excellent cure rates have been achieved by standardization of treatment, interdisciplinary management, and tremendous success in performing clinical trials. Currently, the aims of Testicular Cancer treatment are as follows: for patients with low-stage disease, a reduction in treatment is proposed to improve long-term toxicity in these patients with unaltered life expectancy; for about 10% of patients with advanced disease and poor prognosis, intensification of treatment (including high-dose chemotherapy and new drugs as well as aggressive surgical approaches) is being investigated to improve long-term cure rates. Conclusion Guidelines will improve clinical practice only if they are regularly updated. This update presents the state-of-the-art management of Testicular Cancer patients in 2005.
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cardiovascular disease as a long term complication of treatment for Testicular Cancer
2003Co-Authors: Robert Huddart, A. Norman, M Shahidi, A Horwich, D Coward, J Nicholls, D P DearnaleyAbstract:Effective multi-agent chemotherapy means that most patients with Testicular Cancer are now cured and have a long potential life expectancy. Long term toxicity is therefore an important consideration. Some groups have reported an increased risk of cardiovascular disease in Testicular Cancer survivors. We have investigated whether such a risk exists by undertaking a cross sectional study of cardiovascular morbidity and risk factors in patients treated at our institution between 1982 and 1992.
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incidence of metachronous Testicular Cancer in patients with extragonadal germ cell tumors
2001Co-Authors: Jorg T Hartmann, Sophie D. Fosså, A Horwich, Craig R Nichols, Jean Paul Droz, A Gerl, Jorg Beyer, Jorg Pont, Karim Fizazi, Hartmut HeckerAbstract:Incidence of metachronous Testicular Cancer in patients with extragonadal germ cell tumours. Background: The frequency of subsequent Testicular Cancer (referred to as metachronous Testicular Cancer) in men who have had previous Testicular Cancer is relatively high. The rate of metachronous Testicular Cancer in men with extragonadal germ cell tumors (EGCTs), however, is largely unknown. We conducted a retrospective study of EGCT patients to determine the incidence, cumulative risk, and specific risk factors for metachronous Testicular Cancers. Methods: A standardized questionnaire about patient characteristics, the extent of EGCT disease, any second malignancies, and treatments received was completed for 635 patients with EGCTs identified from the medical records of 11 Cancer centers in Europe and the United States from 1975 through 1996. Comparisons with age group- specific data from the Saarland, Germany, population-based Cancer registry were used to calculate the standardized incidence ratio (SIR). The Kaplan-Meier method was used to analyze survival data and cumulative risk. All statistical tests were two-sided. Results: Sixteen EGCT patients (4.1%) developed metachronous Testicular Cancers, with a median time between diagnoses of 60 months (range, 14-102 months). The risk of developing metachronous Testicular Cancers was statistically significantly increased in patients with EGCTs (observed = 16; expected = 0.26; SIR = 62; 95% confidence interval [CI] = 36 to 99) and in subsets of EGCT patients with mediastinal location (SIR = 31; 95% CI = 8 to 59), retroperitoneal location (SIR = 100; 95% CI = 54 to 172), and nonseminomatous histology (SIR = 75; 95% CI = 43 to 123). The cumulative risk of developing a metachronous Testicular Cancer 10 years after a diagnosis of EGCT was 10.3% (95% CI = 4.9% to 15.6%) and was higher among patients with nonseminomatous EGCTs (14.3%; 95% CI = 6.7% to 21.9%) and retroperitoneal EGCTs (14.2%; 95% CI = 5.6% to 22.8%) than among patients with seminomatous EGCTs (1.4%; 95% CI = 0.0% to 4.2%) and mediastinal EGCTs (6.2%; 95% CI = 0.1% to 12.2%). Conclusions: Patients with EGCTs, particularly those with retroperitoneal or nonseminomatous tumors, but also those with primary mediastinal EGCTs, are at an increased risk of metachronous Testicular Cancer.
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Testicular Cancer incidence in eight northern european countries secular and recent trends
2004Co-Authors: Lorenzo Richiardi, Rino Bellocco, Hansolov Adami, Anna Torrang, Lotti Barlow, Timo Hakulinen, Mati Rahu, Aivars StengrevicsAbstract:Objective: Striking geographic variation and marked increasing secular trends characterize the incidence of Testicular Cancer. However, it is not known whether these patterns have attenuated in recent years and whether they are similar for seminomas and nonseminomas, the two main histologic groups of Testicular Cancer. Method: Cancer registry data, including 27,030 Testicular Cancer cases, were obtained from Denmark, Estonia, Finland, Latvia, Lithuania, Norway, Poland, and Sweden. Between 57 (Denmark) and 9 (Poland) years of registration were covered. Country-specific temporal trends were estimated, with focus on the last decade and seminomas and nonseminomas. Data from the Nordic countries were further analyzed using an age-period-cohort approach. Results: Age-standardized incidence rates increased annually by 2.6% to 4.9% during the study period, with marginal differences between seminomas and nonseminomas. In the last decade, the increasing trend attenuated only in Denmark (annual change, −0.3%; 95% confidence interval, −1.5 to 0.9). In 1995, the highest and the lowest age-standardized incidence rates (per 105) were 15.2 in Denmark and 2.1 in Lithuania. Incidence rates (i.e., for all Cancers and for seminomas and nonseminomas, separately) depended chiefly on birth cohort rather than on calendar period of diagnosis (although both birth cohort and period determined the Danish incidence rates). Conclusions: Testicular Cancer incidence is still increasing, with the exception of Denmark, and a large geographic difference exists. The increasing trend is mainly a birth cohort phenomenon also in recent cohorts. Temporal trends for seminomas and nonseminomas are similar, which suggests that they share important causal factors.
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increase in Testicular Cancer incidence in six european countries a birth cohort phenomenon
1996Co-Authors: Reinhold Bergstrom, Hansolov Adami, Hans H Storm, Matthias Mohner, Anders Ekbom, Steinar Tretli, Witold Zatonski, Lyly TeppoAbstract:Background: For unknown reasons, the age-standardized incidence of Testicular Cancer has shown a rapid increase in virtually all countries (mostly Western) studied. For populations with a sufficiently long period of Cancer registration, this development c
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Testicular Cancer in nine northern european countries
1994Co-Authors: Hansolov Adami, Hans H Storm, Reinhold Bergstrom, Matthias Mohner, Witold Zatooski, Anders Ekbom, Steinar Tretli, Lyly Teppo, Hartwig ZieglerAbstract:The incidence of Testicular Cancer was examined in the Nordic and Baltic countries, Poland and Germany by collaboration among 10 Cancer registries. Population-based registers were used to analyze a total of 34,309 cases, diagnosed from the start of registration (varying from 1943 in Denmark to 1980 in Latvia and Lithuania) through 1989. An approximately 10-fold geographical variation was found in 1980, with the highest age-standardized incidence rate (7.8 per 10(5); world standard population) in Denmark and the lowest (0.9) in Lithuania. During the entire period of registration, incidence increased rapidly in all countries, by 2.3 to 3.4 per cent annually in the Nordic countries and by about 5 per cent in Poland and Germany; there was some evidence of a slower increase in Denmark and Poland after 1975. The rising trend was more pronounced for ages below 30. The age-specific incidence peaked in all countries at ages 25 to 34, but the geographical variation was considerable. Our data indicate that environmental influences on Testicular Cancer are strong. Exposure to causal factors mostly takes place early in life, shows substantial geographical variation, and increases over time, so that the age-standardized incidence doubles every 15 to 25 years. New aetiological hypotheses are needed to accommodate these salient features of the descriptive epidemiology, since risk factors considered so far cannot explain the observed pattern.
