ÖZET

Amaç:

Tek taraflı, küçük (≤2 cm) testiküler kitlelerin preoperatif değerlendirmesinde, benign-malign ayrımını yapabilmede kullanılabilecek ek klinik parametrelerin öngörü değerini araştırarak, parsiyel orşiektomi uygulanabilecek hastaları belirlemeyi amaçladık.

Yöntemler:

Ocak 2010-Aralık 2017 tarihleri arasında radikal orşiektomi yapılan tek taraflı, küçük testiküler kitleye sahip 31 hastanın verileri retrospektif olarak incelendi. Hastaların demografik verileri, histopatolojik tümör tipleri, serum tümör belirteçleri, nötrofil/lenfosit oranı (NLR), monosit/lenfosit oranı (MLR), platelet/lenfosit oranı (PLO), ortalama platelet hacmi (MPV), eritrosit dağılım genişliği (RDW), testiküler disgenezis sendromu (TDS) ve bileşenlerinin varlığı, postoperatif takip verileri kaydedildi. Hastalar tümör histopatolojisine göre benign ve malign olarak iki gruba ayrılarak karşılaştırıldı.

Bulgular:

Ortalama tanı yaşı 29,39±5,90 olan 31 hastanın 11’i benign, 20’si malign patolojiye sahipti. İki grup arasında AFP (p=0,116), β-hCG (p=0,205), LDH (p=0,606), MPV (p=0,087) ve RDW (p=0,266) açısından anlamlı fark görülmezken; malign grupta MLR (p=0,001), NLR (p=0,036) ve PLR (p=0,001) anlamlı olarak daha yüksekti. Testiküler mikrolitiazis (p=0,719), inmemiş testis (p=0,254), hipospadias (p=0,645), atrofik testis (p=0,409) saptanma oranları gruplar arasında farklılık göstermezken; semen parametresi bozukluğu oranı (p=0,043) ve TDS varlığı (p=0,043) malign olgularda belirgin olarak yüksek bulundu. Çok değişkenli analizde, MLR ve PLO’nun ≤2 cm boyutlu testiküler kitlelerde malignbenign ayrımını öngörmede prediktif faktörler olduğunu gözledik.

Sonuç:

Preoperatif olarak malignite şüphesinin dışlanamadığı olgularda, PLO, MLR, NLR, semen parametresi bozuklukları ve TDS varlığının benign-malign ayrımını yapma gücünün yüksek olabileceğini; benign olma olasılığı yüksek olgularda, parsiyel orşiektominin önerilebileceğini düşünmekteyiz.

References

Siegel RL, Miller KD, Jemal A. Cancer statistics. Cancer J Clin 2017;67:7–30.

McGlynn KA, Cook MB. Etiologic factors in testicular germ-cell tumors. Future Oncol 2009;5:1389-402.

Khan MJ, Bedi N, Rahimi MNC, Kalsi J. Testis sparing surgery for small testicular masses and frozen section assessment. Cent European J Urol 2018;71:304-9.

La Rocca R, Capece M, Spirito L, Cumberbatch MK, Creta M, Altieri V, et al ; EAU-ESRU (European Associations of Urology-European Society of Residents Urologist). Testis-sparing surgery for testicular masses: current perspectives. Minerva Urol Nefrol 2019;71:359-64.

Laguna MP, Albers P, Albrecht W, Algaba F, Bokemeyer C, Boormans JL, et al. European Association of Urology guidelines on testicular cancer: the 2019 Update. European Urology 2019;75:799-810.

Galosi AB, Fulvi P, Fabiani A, Servi L, Filosa A, Leone L, et al. Testicular sparing surgery in small testis masses: A multinstitutional experience. Arch Ital Urol Androl 2016;88:320-4.

Ates F, Malkoc E, Zor M, Demirer Z, Alp BF, Basal S, et al. Testis Sparing Surgery in Small Testicular Masses With No Malignancy Suspicion. Clin Genitourin Cancer 2016;14:e49-53.

Xiao F, Shi JZ, Liu Y, Liu T, Wang J, Liu YS, et al. Radical and testis-sparing surgery for primary testicular tumors: A single-center experience. Mol Clin Oncol 2019;10:343-51.

Hanson BM, Eisenberg ML, Hotaling JM. Male infertility: a biomarker of individual and familial cancer risk. Fertil Steril 2018;109:6-19.

van den Driesche S, Kilcoyne KR, Wagner I, Rebourcet D, Boyle A, Mitchell R, et al. Experimentally induced testicular dysgenesis syndrome originates in the masculinization programming window. JCI Insight 2017;2:e91204.

Song G, Xiong GY, Fan Y, Huang C, Kang YM, Ji GJ, et al. The role of tumor size, ultrasonographic findings, and serum tumor markers in predicting the likelihood of malignant testicular histology. Asian J Androl 2019;21:196-200.

Bojanic N, Bumbasirevic U, Bojanic G, Vukovic I, Milojevic B, Pekmezovic T, et al: Testis sparing surgery for treatment of small testicular lesions: Is it feasible even in germ cell tumors? J Surg Oncol 2017;115:287‑90.

Matei DV, Vartolomei MD, Renne G, Tringali VML, Russo A, Bianchi R, et al. Reliability of Frozen Section Examination in a Large Cohort of Testicular Masses: What Did We Learn? Clin Genitourin Cancer 2017;15:e689-96.

Connolly SS, D’Arcy FT, Bredin HC, Callaghan J, Corcoran MO. Value of frozen section analysis with suspected testicular malignancy. Urology 2006;67:162-5.

Shilo Y, Zisman A, Lindner A, Raz O, Strauss S, Siegel YI, et al. The predominance of benign histology in small testicular masses. Urol Oncol 2012;30:719-22.

Shilo Y, Zisman A, Raz O, Lang E, Strauss S, Sandbank J, et al. Testicular sparing surgery for small masses. Urol Oncol 2012;30:188-91.

Kachramanoglou C, Rafailidis V, Philippidou M, Bertolotto M, Huang DY, Deganello A, et al. Multiparametric sonography of hematologic malignancies of the testis: grayscale, color Doppler, and contrast enhanced ultrasound and strain elastographic appearances with histologic correlation. J Ultrasound Med 2017;36:409-20.

Mittal PK, Abdalla AS, Chatterjee A, Baumgarten DA, Harri PA, Patel J, et al. Spectrum of extratesticular and testicular pathologic conditions at scrotal MR imaging. Radiographics 2018;38:806-30.

Acar T, Efe D. Is contrast-enhanced MRI efficient in testicular infarction mimicking testicular tumor on scrotal ultrasound? Turk J Emerg Med 2015;15:192-3.

Hamidi N, Alijla A, Gök B, Asil E, Ardıçoğlu A, Atmaca AF. The Evaluation of Association Between Serum Neutrophil-Lymphocyte Ratio and Pathological Prognostic Factors, Development of Metastases During Follow in Stage I Germ Cell Testicular Tumor Patients. Van Tıp Derg 2018;25:165-70.

Bolat D, Aydoğdu Ö, Polat S, Yarımoğlu S, Bozkurt İH, Yonguç T, et al. Predictive value of preoperative neutrophil-to-lymphocyte ratio on the prognosis of germ cell testicular tumors. Turk J Urol 2017;43:55-61.

Koca O, Kutluhan MA, Akyüz M, Karaman B, Öztürk Ö, Karaman Mİ. Hematological evolution of patients with testicular cancer. J Urol Surg 2017;12:32-5.

Tesfamariam B. Involvement of platelets in tumor cell metastasis. Pharmacol Ther 2016;157:112-9.

Lou XL, Sun J, Gong SQ, Yu XF, Gong R, Deng H. Interaction between circulating cancer cells and platelets: clinical implication. Chin J Cancer Res 2015;27:450-60.

Sekaran P, O’Toole S, Flett M, Cascio S. Increased occurrence of disorders of sex development, prematurity and intrauterine growth restriction in children with proximal hypospadias associated with undescended testes. J Urol 2013;189:1892-6.

van den Driesche S, Kolovos P, Platts S, Drake AJ, Sharpe RM. Inter-relationship between testicular dysgenesis and Leydig cell function in the masculinization programming window in the rat. PLoS One 2012;7:e30111.

Xing JS, Bai ZM. Is testicular dysgenesis syndrome a genetic, endocrine, or environmental disease, or an unexplained reproductive disorder? Life Sci 2018;194:120-9.

Guminska A, Oszukowska E, Kuzanski W, Sosnowski M, Wolski JK, Walczak-Jedrzejowska R. Less advanced testicular dysgenesis is associated by a higher prevalence of germ cell neoplasia. Int J Androl 2010;33:e153-62.

Basiri A, Movahhed S, Parvin M, Salimi M, Rezaeet GH. The histologic features of intratubular germ cell neoplasia and its correlation with tumor behavior. Investig Clin Urol 2016;57:191–5.

Balawender K,Orkisz S, Wisz P. Testicular microlithiasis: what urologists should know. A review of the current literature. Cent European J Urol 2018;71:310-4.

Küçük Testiküler Kitlelerde Parsiyel Orşiektomi Kararını Vermeyi Sağlayacak Ek Preoperatif Parametreler

ÖZET

References