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The role of tumor size, ultrasonographic findings, and serum tumor markers in predicting the likelihood of malignant testicular histology
Gang Song1, Geng-Yan Xiong2, Yu Fan3, Cong Huang4, Yong-Ming Kang5, Guang-Jie Ji6, Jin-Chao Chen7, Zhong-Cheng Xin8, Li-Qun Zhou9
1 Department of Urology, Peking University First Hospital, Beijing 100034, China
Institute of Urology, Peking University, National Urological Cancer Center, Beijing 100034, China
Department of Urology, Suining Central Hospital, Suining 629000, China
Department of Andrology, Peking University First Hospital, Beijing 100034, China
Correspondence Address:
Gang Song
Department of Urology, Peking University First Hospital, Beijing 100034, China; Institute of Urology, Peking University, National Urological Cancer Center, Beijing 100034, China
Zhong-Cheng Xin
Institute of Urology, Peking University, National Urological Cancer Center, Beijing 100034, China; Department of Andrology, Peking University First Hospital, Beijing 100034, China
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/aja.aja_119_18
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The clinical predictive factors for malignant testicular histology remain unclear because of the low prevalence. Therefore, the aim of this study was to investigate predictors of malignant histology for testicular masses and decide more testis-sparing surgeries before surgery. This retrospective study enrolled 325 consecutive testicular mass patients who underwent radical orchiectomy (310/325) or testicular preserving surgery (15/325) from January 2001 to June 2016. The clinicopathological factors, including tumor diameter, cryptorchidism history, ultrasound findings, serum alpha-fetoprotein, and human chorionic gonadotropin (HCG) levels, were collected retrospectively for statistical analysis. A predictive nomogram was also generated to evaluate the quantitative probability. Among all patients, 247 (76.0%) were diagnosed with a malignant testicular tumor and 78 (24.0%) with benign histology. Larger tumor diameter (per cm increased, hazard ratio [HR] = 1.284, P = 0.036), lower ultrasound echo (HR = 3.191, P = 0.001), higher ultrasound blood flow (HR = 3.320, P < 0.001), and abnormal blood HCG (HR = 10.550, P < 0.001) were significant predictive factors for malignant disease in all testicular mass patients. The nomogram generated was well calibrated for all predictions of malignant probability, and the accuracy of the model nomogram measured by Harrell's C statistic (C-index) was 0.92. According to our data, the proportion of patients who underwent radical orchiectomy for benign tumors (24.0%) was much larger than generally believed (10.0%). Our results indicated that the diameter, ultrasonic echo, ultrasonic blood flow, and serum HCG levels could predict the malignancy in testicular mass patients.
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