BACKGROUND: Screening programmes for contralateral carcinoma in situ (CIS) testis in patients with unilateral germ-cell cancer (GCC) have never been evaluated.
We investigated the effect of screening for contralateral CIS in a large nation-wide, population-based study.
PATIENTS AND METHODS: A contralateral single-site biopsy was offered to 4130 patients in whom GCC had been diagnosed in 1984-2007 (screened cohort); 462 patients in whom GCC was diagnosed in 1984-1988 comprised the unscreened cohort. Cases with CIS were offered radiotherapy. Initially CIS-negative biopsies in patients with metachronous GCC were revised according to today's standards. Risk for metachronous GCC was estimated using cumulative incidence and the Cox proportional hazards model.
RESULTS: In the screened cohort, contralateral CIS was found in 181 (4.4%) patients. The cumulative incidence of metachronous GCC after 20 years was 1.9% in the screened cohort and 3.1% in the unscreened cohort (P = 0.097), hazard ratio (HR) for the unscreened cohort: 1.59 (P = 0.144). Expert revision with contemporary methodology of CIS-negative biopsy samples from patients with metachronous cancer revealed CIS in 17/45 (38%) cases. Decreased risks for metachronous GCC were related to older age at diagnosis (HR 0.52 per 10 years, P < 0.001) and chemotherapy (HR 0.35, P = 0.002). Limitations include the small number of patients in the unscreened cohort and the retrospective study design.
CONCLUSIONS: Our evaluation of a national population-based screening programme for contralateral CIS in patients with testicular cancer showed no significant difference in the risk for metachronous GCC between a screened and an unscreened cohort. Single-site biopsy including modern immunohistochemistry does not identify all cases of CIS.
Written by:
Kier MG, Lauritsen J, Almstrup K, Mortensen MS, Toft BG, Rajpert-De Meyts E, Skakkebaek NE, Rørth M, von der Maase H, Agerbaek M, Holm NV, Andersen KK, Dalton SO, Johansen C, Daugaard G. Are you the author?
Department of Oncology 5073, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark; Department of Survivorship, Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen, Denmark; Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark; Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark; Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, Aarhus, Denmark; Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, Odense, Denmark; Department of Statistics, Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen, Denmark; Department of Survivorship, Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen, Denmark.
Reference: Ann Oncol. 2014 Dec 26. pii: mdu585.
doi: 10.1093/annonc/mdu585
PubMed Abstract
PMID: 25542924