Screening for carcinoma in situ in the contralateral testicle in patients with testicular cancer: A population-based study

Maria G.G. Kier*, J. Lauritsen, K. Almstrup, M. S. Mortensen, B. G. Toft, E. Rajpert-De Meyts, N. E. Skakkebaek, M. Rørth, H. Von Der Maase, M. Agerbaek, N. V. Holm, K. K. Andersen, S. O. Dalton, C. Johansen, G. Daugaard

*Corresponding author af dette arbejde

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    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 nationwide, 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 out of 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.

    Sider (fra-til)737-742
    Antal sider6
    TidsskriftAnnals of Oncology
    Udgave nummer4
    StatusUdgivet - 1 apr. 2015


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