Long‐term oncological outcomes of patients with paratesticular sarcoma

• Published in: BJU international Vol. 124; no. 5; pp. 801 - 810
• Main Authors: Goldberg, Hanan, Wong, Lih‐Ming, Dickson, Brendan, Catton, Charles, Yap, Stanley A., Alkasab, Thamir, Evans, Andrew, Kwast, Theodorus, Jewett, Michael A. S., Hamilton, Robert J.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-11-2019
• Subjects: hemiscrotectomy; local recurrence; Metastases; Metastasis; paratesticular sarcoma; positive surgical margins; Sarcoma; Surgery; TesticularCancer; tscsm; Tumors; local recurrence; paratesticular sarcoma; hemiscrotectomy; tscsm; TesticularCancer; positive surgical margins
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/bju.14775

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.