Chahine Sophia Y, Alkhatib Khalid Y, Arakelyan Gevorg, Buxton Claire, Giannarini Gianluca, Hamilton Robert J, Holt Sarah K, Bernhard Jean-Christophe, Jiang Di Maria, Lin Daniel, Liu Jen-Jane, Manley Brandon, Master Viraj A, Matveev Vsevolod, Necchi Andrea, Packiam Vignesh T, Patel Sunil H, Peak Taylor, Peyton Charles C, Pierorazio Phillip M, Prakash Gagan, Salari Keyan, Sexton Wade J, Singla Nirmish, Spiess Philippe E, Psutka Sarah P
University of Washington School of Medicine, Seattle, WA, USA.
Department of Urology, University of Pennsylvania, Philadelphia, PA, USA.
Eur Urol Focus. 2025 Jan;11(1):94-99. doi: 10.1016/j.euf.2024.07.017. Epub 2024 Aug 14.
There are limited data on the prevalence and management of testicular germ cell tumor (TGCT) cases presenting with venous tumor thrombus (VTT). Our objectives were to describe the prevalence of TGCT with VTT, to identify a multicenter retrospective cohort, and to ascertain expert opinion regarding optimal management of this entity.
Using the IBM Marketscan database, we identified men with testicular cancer who underwent retroperitoneal lymph node dissection (RPLND) with concurrent VTT or inferior vena cava (IVC) tumor thrombectomy to estimate the prevalence of VTT in TGCT. To identify a multicenter retrospective cohort of patients, we surveyed surgeons and described the presentation, management, and outcomes for the cohort.
The prevalence of TGCT with VTT in the IBM Marketscan database was 0.3% (n = 7/2517) when using stringent criteria and 3.1% (n = 79/2517) when using broad criteria. In response to our survey, 16 surgeons from ten centers contributed data for 34 patients. Most patients (n = 29, 85%) presented with nonseminomatous germ cell tumor. Surgical management was used for 93.9% (n = 31), including postchemotherapy tumor thrombectomy with primary cavorrhaphy in 63%. The Marketscan analysis was limited to insured individuals and did not include clinicopathological details, and use of billing codes may have included patients with stromal tumors. In addition, lack of responses to the anonymous survey limited data capture, and the RedCap survey did not address symptoms specific to IVC obstruction or allow central review of the imaging leading to VTT diagnosis.
VTT among males with TGCT is rare and requires complex multidisciplinary management, including venous tumor thrombectomy at the time of postchemotherapy RPLND.
Using a medical database, we estimated that the frequency of testicular cancer cases in which the tumor extends into a blood vessel (called venous tumor thrombus, VTT) is just 0.3-3.1%. We carried out a survey of surgeons with experience of this condition. Our results indicate that although testicular cancers respond well to chemotherapy, VTT is less responsive and complex surgery is necessary for this rare condition.
关于伴有静脉瘤栓（VTT）的睾丸生殖细胞肿瘤（TGCT）病例的患病率及管理的数据有限。我们的目标是描述伴有VTT的TGCT的患病率，确定一个多中心回顾性队列，并确定关于该实体最佳管理的专家意见。
利用IBM Marketscan数据库，我们识别出接受腹膜后淋巴结清扫术（RPLND）并同时进行VTT切除或下腔静脉（IVC）肿瘤血栓切除术的睾丸癌男性患者，以估计TGCT中VTT的患病率。为了确定一个多中心回顾性患者队列，我们对外科医生进行了调查，并描述了该队列的临床表现、管理及结局。
在IBM Marketscan数据库中，使用严格标准时伴有VTT的TGCT患病率为0.3%（n = 7/2517），使用宽泛标准时为3.1%（n = 79/2517）。针对我们的调查，来自十个中心的16位外科医生提供了34例患者的数据。大多数患者（n = 29，85%）表现为非精原细胞性生殖细胞肿瘤。93.9%（n = 31）的患者采用了手术治疗，其中63%为化疗后肿瘤血栓切除术并一期腔静脉修补术。Marketscan分析仅限于参保个体，未包括临床病理细节，计费代码的使用可能纳入了间质瘤患者。此外，对匿名调查的无回应限制了数据收集，且RedCap调查未涉及IVC梗阻的特定症状，也未允许对导致VTT诊断的影像学进行集中审查。
男性TGCT患者中VTT罕见，需要复杂的多学科管理，包括化疗后RPLND时的静脉瘤栓切除术。
利用一个医学数据库，我们估计肿瘤延伸至血管（称为静脉瘤栓，VTT）的睾丸癌病例的发生率仅为0.3 - 3.1%。我们对有该疾病治疗经验的外科医生进行了一项调查。我们的结果表明，尽管睾丸癌对化疗反应良好，但VTT反应较差，对于这种罕见情况需要进行复杂手术。
