Long-term oncological outcomes of patients with paratesticular sarcoma

Hanan Goldberg, Lih Ming Wong, Brendan Dickson, Charles Catton, Stanley Yap, Thamir Alkasab, Andrew Evans, Theodorus van der Kwast, Michael A.S. Jewett, Robert J. Hamilton

Research output: Contribution to journalArticle

Abstract

Objectives: To present long-term oncological outcomes of patients with paratesticular sarcoma treated by a multidisciplinary team. Patients and methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish (US)
JournalBJU International
DOIs
StatePublished - Jan 1 2019

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Sarcoma
Recurrence
Neoplasm Metastasis
Survival
Confidence Intervals
Neoplasms
Pathology

Keywords

  • #TesticularCancer
  • #tscsm
  • hemiscrotectomy
  • local recurrence
  • paratesticular sarcoma
  • positive surgical margins

ASJC Scopus subject areas

  • Urology

Cite this

Goldberg, H., Wong, L. M., Dickson, B., Catton, C., Yap, S., Alkasab, T., ... Hamilton, R. J. (2019). Long-term oncological outcomes of patients with paratesticular sarcoma. BJU International. https://doi.org/10.1111/bju.14775

Long-term oncological outcomes of patients with paratesticular sarcoma. / Goldberg, Hanan; Wong, Lih Ming; Dickson, Brendan; Catton, Charles; Yap, Stanley; Alkasab, Thamir; Evans, Andrew; van der Kwast, Theodorus; Jewett, Michael A.S.; Hamilton, Robert J.

In: BJU International, 01.01.2019.

Research output: Contribution to journalArticle

Goldberg, H, Wong, LM, Dickson, B, Catton, C, Yap, S, Alkasab, T, Evans, A, van der Kwast, T, Jewett, MAS & Hamilton, RJ 2019, 'Long-term oncological outcomes of patients with paratesticular sarcoma', BJU International. https://doi.org/10.1111/bju.14775
Goldberg, Hanan ; Wong, Lih Ming ; Dickson, Brendan ; Catton, Charles ; Yap, Stanley ; Alkasab, Thamir ; Evans, Andrew ; van der Kwast, Theodorus ; Jewett, Michael A.S. ; Hamilton, Robert J. / Long-term oncological outcomes of patients with paratesticular sarcoma. In: BJU International. 2019.
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abstract = "Objectives: To present long-term oncological outcomes of patients with paratesticular sarcoma treated by a multidisciplinary team. Patients and methods: 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. Results: 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. Conclusion: 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.",
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AU - Goldberg, Hanan

AU - Wong, Lih Ming

AU - Dickson, Brendan

AU - Catton, Charles

AU - Yap, Stanley

AU - Alkasab, Thamir

AU - Evans, Andrew

AU - van der Kwast, Theodorus

AU - Jewett, Michael A.S.

AU - Hamilton, Robert J.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: To present long-term oncological outcomes of patients with paratesticular sarcoma treated by a multidisciplinary team. Patients and methods: 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. Results: 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. Conclusion: 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.

AB - Objectives: To present long-term oncological outcomes of patients with paratesticular sarcoma treated by a multidisciplinary team. Patients and methods: 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. Results: 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. Conclusion: 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.

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KW - local recurrence

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