Clinical Profile, Treatment and Survival Outcome of Testicular Tumors: A Pakistani Perspective

  • Bhatti, Abu Bakar Hafeez ;
  • Ahmed, Irfan ;
  • Ghauri, Rashid Khan ;
  • Saeed, Qamar ;
  • Mir, Khurram
  • Published : 2014.01.15


Background: Testicular cancer management is considered a marvel of modern science with excellent treatment results. Pakistan has a distinct ethnic variation and geographic distribution but data regarding clinical presentation of testicular tumors and their management is under reported. The objective of this study was to determine clinical profile, treatment modalities and survival outcome of testicular tumors in the Pakistani population. Materials and Methods: A retrospective review of patients who received treatment for testicular cancer at Shaukat Khanum Cancer Hospital from January 2009 to December 2012 was performed. Patient demographics, clinical features at presentation and treatment modalities were assessed. For categorical variables chi square test was used. Survival was calculated using Kaplan Meier survival curves and Log rank test was employed to determine significance. Results: The most common tumor was mixed germ cell tumor in 49% patients. For all tumor variants except seminoma, stage III was the most common clinical stage at presentation. Majority of patients with non seminomatous germ cell tumors presented in the15-30 year age group as compared to seminoma which was most prevalent in the 30-40 year age group. Orchiectomy followed by chemotherapy was the most common treatment modality in 80% patients. Expected 5 year survival for seminomas and non-seminomatous germ cell tumors was 96% and 90% respectively which was not significantly different (p=0.2). Conclusions: Despite a distinct clinical profile of testicular tumors in Pakistani population, survival is comparable with published reports.


Testicular neoplasms;survival;seminoma;germ cell tumor


  1. Travis LB, Fossa SD, Schonfeld SJ, et al (2005). Second cancers among 40,576 testicular cancer patients: focus on long-term survivors. J Natl Cancer Inst, 97, 1354-65.
  2. Stang A, Rusner C, Eisinger B, Stegmaier C, Kaatsch P (2009). Subtype specific incidence of testicular cancer in Germany: a pooled analysis of nine population-based cancer registries. Int J Androl, 32, 306-16.
  3. Sataa S, Nfoussi H, Abaza H, et al (2012). Testicular cancer patterns in Tunisian men: diagnosis problems, pathological types and prognosis. About 41 patients. Tunis Med, 90, 613-8.
  4. Shin YS, Kim HJ (2013).Current management of testicular cancer. Korean J Urol, 54, 2-10.
  5. Tan GH, Azrif M, Shamsul AS, et al (2011). Clinicopathological features and survival of testicular tumours in a Southeast Asian university hospital: a ten-year review. Asian Pac J Cancer Prev, 12, 2727-30.
  6. Van den Belt-Dusebout AW, de Wit R, Gietema JA, et al (2007). Treatment-specific risks of second malignancies and cardiovascular disease in 5-year survivors of testicular cancer. J Clin Oncol, 25, 4370-8.
  7. Wanderas EH, Tretli S, Fossa SD (1995). Trends in incidence of testicular cancer in Norway 1955-1992. Eur J Cancer, 31, 2044-8.
  8. Ward KD, Vander Weg MW, Read MC, Sell MA, Beech BM (2005). Testicular cancer awareness and self-examination among adolescent males in a community-based youth organization. Prev Med, 41, 386-98.
  9. Walschaerts M, Huyghe E, Muller A, et al (2008). Doubling of testicular cancer incidence rate over the last 20 years in southern France. Cancer Causes Control, 19, 155-61.
  10. Zagars GK, Ballo MT, Lee AK, Strom SS (2004). Mortality after cure of testicular seminoma. J Clin Oncol, 22, 640-7.
  11. Purdue MP, Devesa SS, Sigurdson AJ, McGlynn KA (2005). International patterns and trends in testis cancer incidence. Int J Cancer, 115, 822-7.
  12. Nguyen MM, Ellison LM (2005). Testicular cancer patterns in Asian-American males: an opportunity for public health education to impact outcomes. Urol, 66, 606-9.
  13. Ondrus D, Hornak M, Matoska J, Kausitz J, Belan V (1992). Primary chemotherapy in the management of low stage (IIA and IIB) non-seminomatous germ cell testicular tumours. Int Urol Nephrol, 24, 299-304.
  14. Pont J, Albrecht W, Postner G, et al (1996). Adjuvant chemotherapy for high-risk clinical stage I nonseminomatous testicular germ cell cancer: long-term results of a prospective trial. J Clin Oncol, 14, 441-8.
  15. Shah MN, Devesa SS, Zhu K, McGlynn KA (2007). Trends in testicular germ cell tumours by ethnic group in the United States. Int J Androl, 30, 206-13.
  16. Franks P, Fiscella, K, Meldrum S (2005). Racial disparities in the content of primary care office visits. J Gen Intern Med, 20, 599-603.
  17. Chia VM, Quraishi SM, Devesa SS, et al (2010). International trends in the incidence of testicular cancer, 1973-2002. Cancer Epidemiol Biomarkers Prev, 19, 1151-9.
  18. Cost NG (2013). Testicular germ cell tumors Current concepts and management strategies. Minerva Urol Nefrol, 65, 133-55.
  19. Einhorn LH, Williams SD, Loehrer PJ, et al (1989). Evaluation of optimal duration of chemotherapy in favorable-prognosis disseminated germ cell tumors: a Southeastern Cancer Study Group protocol. J Clin Oncol, 7, 387-91.
  20. Gilligan TD, Seidenfeld J, Basch EM, et al (2010). American Society of Clinical Oncology Clinical Practice Guideline on uses of serum tumor markers in adult males with germ cell tumors. J Clin Oncol, 28, 3388-404.
  21. Horwich A, Sleijfer DT, Fossa SD, et al (1997). Randomized trial of bleomycin, etoposide, and cisplatin compared with bleomycin, etoposide, and carboplatin in good-prognosis metastatic nonseminomatous germ cell cancer: a Multi institutional Medical Research Council/European Organization for Research and Treatment of Cancer Trial. J Clin Oncol, 15, 1844-52.
  22. Klein EA (1993). Tumour markers in testis cancer. Urol Clin North Am, 20, 67-73.
  23. Kobayashi K, Saito T, Kitamura Y, et al (2013). Oncological outcomes in patients with stage I testicular seminoma and nonseminoma: pathological risk factors for relapse and feasibility of surveillance after orchiectomy. Diagn Pathol, 8, 57.
  24. Mushtaq S, Jamal S, Mamoon N, Akbar N, Khadim T (2007). The pathological spectrum of malignant testicular tumours in northern Pakistan. J Pak Med Assoc, 57, 499-501.
  25. Albers P, Albrecht W, Algaba F, et al (2005). Guidelines on testicular cancer. Eur Urol, 48, 885-94.
  26. Bokemeyer C, Kohrmann O, Tischler J, et al (1996). A randomized trial of cisplatin, etoposide and bleomycin (PEB) versus carboplatin, etoposide and bleomycin (CEB) for patients with 'good-risk' metastatic non-seminomatous germ cell tumors. Ann Oncol, 7, 1015-21.
  27. Bhutani M, Kumar L, Seth A, et al (2002).Germ cell tumours of the testis: clinical features, treatment outcome and prognostic factors. Natl Med J India, 15, 18-21.
  28. Biggs ML, Schwartz SM (2004). Differences in testis cancer survival by race and ethnicity: a population-based study, 1973-1999 (United States). Cancer Causes Control, 15, 437-44.
  29. Bray F, Ferlay J, Devesa SS, McGlynn KA, Moller H (2006). Interpreting the international trends in testicular seminoma and non seminoma incidence. Nat Clin Pract Urol, 3, 532-43.
  30. Bray F, Richiardi L, Ekbom A, et al (2006). Do testicular seminoma and nonseminoma share the same etiology? Evidence from an age period-cohort analysis of incidence trends in eight European countries. Cancer Epidemiol Biomarkers Prev, 15, 652-8.
  31. Beard CJ, Travis LB, Chen MH, et al (2013). Outcomes in stage I testicular seminoma: a population-based study of 9193 patients. Cancer, 119, 2771-7.

Cited by

  1. Distribution of Testicular Tumors in Lebanon: A Single Institution Overview vol.16, pp.8, 2015,