Harun, Ahmad Khairul Irham
(2018)
Review of testicular cancer from 2000 until 2015 in HUSM.
Masters thesis, Universiti Sains Malaysia.
Abstract
Background
Testicular cancer is a rare malignancy worldwide, especially among Asians. Even though it is
associated with 98% survival, it is mainly a disease of young adults and the incidence is
increasing worldwide. There is no reported survival outcome among testicular cancer patients
who are treated in Hospital Universiti Sains Malaysia (HUSM), Kubang Kerian. This study aims
to analyze the 5-years OS and PFS and associated predictive factor for survival among testicular
cancer patients treated in HUSM.
Methodology
This is a retrospective cohort study performed in HUSM. All histopathology confirmed cases of
testicular cancer are included. Patient demographics, histopathological findings of the surgical
specimen, serum tumor markers, relevant radiological findings, treatment modalities received
and patient survival status until 31st July 2017 were reviewed. Kaplan-Meier plot was used to
calculate 5-years OS and PFS. Log-rank test and Pairwise comparison were used to calculate the
survival difference between two or more groups. Univariate Cox regression analysis was used to
analyze the association between predictive factors and survival outcome.
Results
Sixty-two (62) patients were included in the study with a median follow-up of 20.5 months.
Median age at diagnosis is 33 years and 95% of patients are from Malay ethnic group. Nonseminomatous
Germ-cell tumor (NSGCT) is the most common tumor subgroup comprising
66.1%. More than 65% of patients presented with metastatic disease at presentation. Five-year
OS is 68.4%, 64.2% and 33.3% for NSGCT, seminoma and non-germ cell tumor (NGCT)respectively. Five-year PFS is 51.0%, 41.0% and 26.7% for NSGCT, seminoma and NGCT
respectively. Co-existing Diabetes/ hypertension (HR= 3.72, 95% CI: 1.52 – 9.11; p= 0.004),
Non-germ cell histology (HR= 4.11, 95% CI: 1.52 – 11.14; p= 0.005) and presence of spermatic
cord invasion (HR= 3.30, 95% CI: 1.12 – 9.77; p=0.031) are associated with poor OS. Age group
51 to 60 years is the only predictive factor for poorer OS (HR= 9.65, 95% CI: 2.05 – 45.5; p=
0.004) and PFS (HR= 10.25, 95% CI: 2.29 – 45.9; p= 0.002).
Conclusion
Testicular cancer is a rare disease which mainly affects young Malay males. NSGCT is the
commonest subtype encountered and is associated with the highest OS and PFS. Age 51 to 60 is
associated with worse OS and PFS. Meanwhile, co-existing Diabetes or hypertension, non-Germ
cell histology, and presence of spermatic cord invasion are predictors of poor OS.
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