Malignant Testicular Tumors in Children: A Single Institution's 12-year Experience

Background and Objectives. Testicular neoplasms are not commonly found in children, a formidable threat if treated inappropriately. However, there is no consensus concerning their management. The study aimed to present a holistic picture of the integrated treatment of malignant testicular tumors based on our 12 years' experience.

Patients and Methods. This institutional-based retrospective cohort study evaluated clinical presentation, histopathologic diagnosis, treatment, and outcome in 42 boys with malignant neoplasm of testis treated between 2006 and 2019.

Study Overview

• Status: Completed
• Conditions: Overall Survival Rates
• Intervention / Treatment: Procedure: Orchiectomy

Detailed Description

Study Design. We retrospectively investigated the outcomes of 42 boys aged 0-19 years presenting with testicular masses. Excluding patients with incomplete records, they were treated at a tertiary referral center between May 2006 and November 2019, which were reviewed and retrospectively analyzed based on their age at the time of admission, presenting complaints, clinical and radiological findings, tumor markers, management, and follow-up. Pathology was centrally reviewed (C.H.) in patients with a tissue biopsy, but confirmation by a central review was not required before enrollment. This retrospective study was unanimously approved by the institutional review board of Chang Gung Memorial Hospital. Their parents or legal guardians provided written informed consent through an opt-out method on our hospital website following the ethical principles for medical research involving human subjects in Taiwan.

Data Collection. The evaluation included age at presentation, medical history, clinical characteristics, diagnostic procedures, treatment methods, histopathologic findings, and outcomes for every patient. All patients received the examinations of color Doppler ultrasonography of the testis and the abdomen, plain x-ray of the thorax, and serum α-fetoprotein (AFP) levels before operations. The AFP measurement is usually very high in newborns and does not decrease to normal adult levels until 8 months. Thus, the AFP levels of infants were evaluated according to reference ranges [4,5].

Surgical Technique All 42 tumors were treated surgically. We explored the groin through an inguinal incision. The testicle is gently grasped and exteriorized, and the spermatic cord and vessels within the tunica vaginalis are clamped. The resected tumor mass was sent for frozen section examination (FSE). Testis-sparing surgery was considered in patients with non-germ cell tumors. If the tumor had replaced the entire testis, a radical orchiectomy was taken. All tumors received histologic analysis. The optimal follow-up protocol included regular control visits with the physical examination, AFP measurements, and testicular sonography. Adjuvant chemotherapy was administered, depending on histopathology and TNM criteria for tumor classification. If non-germ cell tumors were assessed accurately on FSE, testis-sparing surgery could be considered an alternative treatment modality.

• Study Type: Observational
• Enrollment (Actual): 42

Contacts and Locations

Study Locations

• Taiwan
  • Other
    • Taoyuan, Other, Taiwan, 33315
      • Chang Gung Memorial Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 1 second to 19 years (Child, Adult)
• Accepts Healthy Volunteers: N/A
• Genders Eligible for Study: Male

• Sampling Method: Probability Sample

Study Population

The evaluation included age at presentation, medical history, clinical characteristics, diagnostic procedures, treatment methods, histopathologic findings, and outcomes for every patient. All patients received the examinations of color Doppler ultrasonography of the testis and the abdomen, plain x-ray of the thorax, and serum α-fetoprotein (AFP) levels before operations. The AFP measurement is usually very high in newborns and does not decrease to normal adult levels until 8 months. Thus, the AFP levels of infants were evaluated according to reference ranges.

Description

Inclusion Criteria:

• aged 0-19 years presenting with malignant testicular masses

Exclusion Criteria:

• patients with incomplete records

Study Plan

How is the study designed?

Design Details

• Observational Models: Case-Only
• Time Perspectives: Retrospective

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The 1- and 5-year overall survival rates	Malignant testicular tumors in children:	between May 2006 and November 2019

Collaborators and Investigators

• Sponsor: Chang Gung Memorial Hospital

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2020
• Primary Completion (Actual): February 28, 2021
• Study Completion (Actual): February 28, 2021

Study Registration Dates

• First Submitted: March 28, 2021
• First Submitted That Met QC Criteria: March 31, 2021
• First Posted (Actual): April 1, 2021

Study Record Updates

• Last Update Posted (Actual): April 1, 2021
• Last Update Submitted That Met QC Criteria: March 31, 2021
• Last Verified: March 1, 2021

More Information

Terms related to this study

• Keywords: Testicular tumor, children, histology, orchiectomy, inguinal approach
• Additional Relevant MeSH Terms: Neoplasms; Urogenital Neoplasms; Neoplasms by Site; Endocrine System Diseases; Gonadal Disorders; Endocrine Gland Neoplasms; Genital Neoplasms, Male; Testicular Diseases; Testicular Neoplasms
• Other Study ID Numbers: 20201912B0

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Undecided

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No