The impact of age at orchiopexy on testicular cancer outcomes
- PDF / 683,794 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 62 Downloads / 180 Views
ORIGINAL ARTICLE
The impact of age at orchiopexy on testicular cancer outcomes Margaret Higgins1 · Derek E. Smith2 · Dexiang Gao2 · Duncan Wilcox3 · Nicholas G. Cost3 · Amanda F. Saltzman1,3 Received: 20 September 2019 / Accepted: 20 November 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Purpose To estimate how many boys with UDT must undergo orchiopexy to prevent one case of TC, one death from TC and one exposure to TC treatment beyond radical orchiectomy as compared to being treated at an older age. Methods This retrospective study utilized data from a 2007 Swedish study of males who underwent orchiopexy for UDT (Pettersson et al.). TC incidence for boys undergoing orchiopexy for UDT was assessed based on the age at orchiopexy (0–6 years, 7–9 years, 10–12 years, 13–15 years). The incidence of TC in each age cohort was calculated and used to determine the number needed to treat (NNT) for each age group using assumptions based on published TC outcomes. Results For an index patient ≤ 6 years, 372 boys need to undergo orchiopexy to prevent a single case of TC, 1488 boys to prevent exposure to TC therapy beyond radical orchiectomy, and 5315 boys to prevent a single TC-related death compared to treatment at an older age. Conclusion While there is evidence supporting benefits of early orchiopexy, the NNT to affect TC outcomes is very high. Even those with delayed orchiopexies have low risk for TC poor outcomes. This information can be used when counseling patients and families faced with UDT about the risks related to TC, especially with comorbidities. Keywords Testicular cancer · Undescended testicle · Orchiopexy · Number needed to treat Abbreviations NNT Number needed to treat TC Testicular cancer UDT Undescended testicle(s)
Introduction An undescended testicle(s) (UDT) occurs in 2–5% of fullterm newborn males, with the incidence increasing with prematurity [1]. Spontaneous descent usually occurs in the first 3–6 months of life, decreasing the UDT rate to 1% [2].
* Amanda F. Saltzman [email protected] 1
Department of Urology, University of Kentucky, 800 Rose Street, MS 237, Lexington, KY 40536, USA
2
Department of Pediatrics, University of Colorado School of Medicine and University of Colorado Cancer Center, Aurora, CO, USA
3
Division of Urology, Department of Surgery, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, USA
It is established that UDT adversely impacts fertility and testicular cancer (TC) risk in boys [3, 4]. The incidence of TC in the overall population is 1–4% in America, and TC is the most commonly diagnosed malignancy in men of age 20–45 years [5]. Of patients diagnosed with TC, 5–10% have a personal history of UDT [1, 5]. The relative risk of TC in the UDT population is 2.75–8 × higher than in males without UDT [5]. TC has excellent longterm outcomes, with 5-year overall survival around 95% [6]. Younger men with TC are more likely to present with clinical stage I disease, treatment of which has shifted
Data Loading...
