Long-term oncological outcomes of patients with paratesticular sarcoma.
#TesticularCancer
#tscsm
hemiscrotectomy
local recurrence
paratesticular sarcoma
positive surgical margins
Journal
BJU international
ISSN: 1464-410X
Titre abrégé: BJU Int
Pays: England
ID NLM: 100886721
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
pubmed:
20
4
2019
medline:
2
6
2020
entrez:
20
4
2019
Statut:
ppublish
Résumé
To present long-term oncological outcomes of patients with paratesticular sarcoma treated by a multidisciplinary team. Patients managed at the Princess Margaret Cancer Centre, between 1990 and 2012, were analysed. A sarcoma expert performed central pathology review. Kaplan-Meier graphs compared local recurrence (LR), metastasis, and overall survival (OS) of patients treated with hemiscrotectomy vs those who did not. Univariable Cox proportional hazards analysis was performed to delineate predictors of LR, metastasis, and OS. Overall, 51 patients with a median (interquartile range) follow-up of 132 (51.6-226.8) months were analysed. At presentation, 92.2% (47 patients) had localised disease. Only five patients (9.8%) had undergone initially planned hemiscrotectomy. Completion and salvage hemiscrotectomy was performed in 25 (54.3%) and seven (15.2%) patients, respectively. Recurrence and metastasis occurred in 12 (25.5%) and 10 patients (19.6%), respectively. At the last follow-up, 21.6% (11 patients) had died, with eight dying from their disease. Kaplan-Meyer graphs demonstrated that hemiscrotectomy improved LR (median not reached vs 62.4 months, log-rank P = 0.008) and OS (median not reached vs 168 months, log-rank P = 0.081). Univariable analysis found hemiscrotectomy to be associated with a lower LR rate (hazard ratio [HR] 0.21, P = 0.02), whilst positive margins at initial surgery were associated with increased LR (HR 4.81, P = 0.047). No metastasis predictors were found, but age (HR 1.04, 95% confidence interval [CI] 1.0-1.08; P = 0.02) and non-localised disease at presentation (HR5.17, 95% CI 1.33-20.06; P = 0.017) were associated with worse OS. Paratesticular sarcoma is a rare tumour, predominantly manifesting as localised disease. Most patients receive an initial suboptimal oncological surgery. Improved long-term outcomes are demonstrated following early hemiscrotectomy.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
801-810Informations de copyright
© 2019 The Authors BJU International © 2019 BJU International Published by John Wiley & Sons Ltd.
Références
Priemer DS, Trevino K, Chen S, Ulbright TM, Idrees MT. Paratesticular soft-tissue masses in orchiectomy specimens: A 17-year survey of primary and incidental cases from one institution. Int J Surg Pathol 2017; 25: 480-7
Srigley JR, Hartwick RW. Tumors and cysts of the paratesticular region. Pathol Annu 1990; 25: 51-108
Khoubehi B, Mishra V, Ali M, Motiwala H, Karim O. Adult paratesticular tumours. BJU Int 2002; 90: 707-15
Park SB, Lee WC, Kim JK et al. Imaging features of benign solid testicular and paratesticular lesions. Eur Radiol 2011; 21: 2226-34
Wibmer C, Leithner A, Zielonke N, Sperl M, Windhager R. Increasing incidence rates of soft tissue sarcomas? A population-based epidemiologic study and literature review. Ann Oncol 2010; 21: 1106-11
Coleman J, Brennan MF, Alektiar K, Russo P. Adult spermatic cord sarcomas: management and results. Ann Surg Oncol 2003; 10: 669-75
Rodriguez D, Olumi AF. Management of spermatic cord tumors: a rare urologic malignancy. Ther Adv Urol 2012; 4: 325-34
Ap Dafydd D, Messiou C, Thway K, Strauss DC, Nicol DL, Moskovic E. Paratesticular sarcoma: typical presentation, imaging features, and clinical challenges. Urology 2017; 100: 163-8
Ballo MT, Zagars GK, Pisters PW, Feig BW, Patel SR, von Eschenbach AC. Spermatic cord sarcoma: outcome, patterns of failure and management. J Urol 2001; 166: 1306-10
Enoch S, Wharton SM, Murray DS. Management of leiomyosarcomas of the spermatic cord: the role of reconstructive surgery. World J Surg Oncol 2005; 3: 23
Catton C, Jewett M, O'Sullivan B, Kandel R. Paratesticular sarcoma: failure patterns after definitive local therapy. J Urol 1999; 161: 1844-7
Moroni M, Nesi G, Travaglini F, Rizzo M, Amorosi A, Dominici A. Rhabdomyosarcoma of the spermatic cord. A case report with review of the literature. Urol Int 2003;71:114-17
Khandekar MJ, Raut CP, Hornick JL, Wang Q, Alexander BM, Baldini EH. Paratesticular liposarcoma: unusual patterns of recurrence and importance of margins. Ann Surg Oncol 2013; 20: 2148-55
Montgomery E, Fisher C. Paratesticular liposarcoma: a clinicopathologic study. Am J Surg Pathol 2003; 27: 40-7
Fagundes MA, Zietman AL, Althausen AF, Coen JJ, Shipley WU. The management of spermatic cord sarcoma. Cancer 1996; 77: 1873-6
Radaelli S, Desai A, Hodson J et al. Prognostic factors and outcome of spermatic cord sarcoma. Ann Surg Oncol 2014; 21: 3557-63
Mohrs OK, Thoms H, Egner T et al. MRI of patients with suspected scrotal or testicular lesions: diagnostic value in daily practice. AJR Am J Roentgenol 2012; 199: 609-15
Secil M, Bertolotto M, Rocher L et al. Imaging features of paratesticular masses. J Ultrasound Med 2017; 36: 1487-509
Akbar SA, Sayyed TA, Jafri SZ, Hasteh F, Neill JS. Multimodality imaging of paratesticular neoplasms and their rare mimics. Radiographics 2003;23:1461-76
Raza M, Vinay HG, Ali M, Siddesh G. Bilateral paratesticular liposarcoma - a rare case report. J Surg Tech Case Rep 2014; 6: 15-17
Dall'Igna P, Bisogno G, Ferrari A et al. Primary transcrotal excision for paratesticular rhabdomyosarcoma: is hemiscrotectomy really mandatory? Cancer 2003;97:1981-4
Dangle PP, Correa A, Tennyson L, Gayed B, Reyes-Mugica M, Ost M. Current management of paratesticular rhabdomyosarcoma. Urol Oncol 2016; 34: 84-92
Rodriguez D, Barrisford GW, Sanchez A, Preston MA, Kreydin EI, Olumi AF. Primary spermatic cord tumors: disease characteristics, prognostic factors, and treatment outcomes. Urol Oncol 2014; 32: 52.e19-25