Naufal Naushad, Tarek Shendy, Tanveer Mahmood, Abdalla Deb, Hosam Serag, Abraham Vinod Peedikayil
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Tumor volume was calculated from ultrasound dimensions using the ellipsoid formula. For bilateral metastases, the mean volume was used in regression analysis.</p><p><strong>Results: </strong>The median overall survival was 17 months (interquartile ranges [IQR], 7.4-26), and progression-free survival was 9 months (IQR, 6-18.5). Lymph node metastasis (odds ratio [OR] = 15.7, P = .019) and presence of metastases at RCC diagnosis (OR = 6.5, P = .034) were associated with mortality. Synchronous metastases (OR = 38.5, P = .002) and lung involvement (OR = 28.0, P = .004) were predictors of recurrence. Survival differed significantly across Fuhrman grades (P = .032) and T stages (P = .047). 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引用次数: 0
摘要
目的：对肾细胞癌（RCC）睾丸转移进行迄今为止规模最大、最全面的个体患者数据（IPD）荟萃分析，目的是表征临床特征，量化生存结果，并确定复发和死亡率的预测因素。方法：于2025年4月使用PubMed、Scopus、Web of Science和谷歌Scholar进行系统综述。符合条件的研究包括组织学证实的肾细胞癌睾丸转移，并可提取患者水平数据。纳入40篇文献中的53例。其中包括我们机构一个未发表的病例。我们提取了人口统计学、病理学、治疗、影像学和结果数据。利用椭球公式从超声尺寸计算肿瘤体积。对于双侧转移瘤，采用平均体积进行回归分析。结果：中位总生存期为17个月（IQR, 7.4-26），无进展生存期为9个月（IQR, 6-18.5）。淋巴结转移（OR=15.7, p=0.019）和RCC诊断时存在转移（OR=6.5, p=0.034）与死亡率相关。同步转移（OR=38.5, p=0.002）和肺部受累（OR=28.0, p=0.004）是复发的预测因素。生存率在Fuhrman分级（p=0.032）和T期（p=0.047）之间差异显著。在Cox回归中，诊断时的转移预测较短的总生存期，而肺和淋巴结累及是最强的复发预测因子。结论：该荟萃分析首次提供了睾丸癌转移的合并生存估计和预后模型。研究结果支持早期发现的价值，并证实了同步疾病和淋巴结扩散对预后的影响。这些结果为受影响患者的临床风险分层和长期监测策略奠定了基础。
Uncovering the Rare: A Systematic Review and Patient-level Meta-analysis of Testicular Metastases From Renal Cell Carcinoma.
Objective: To conduct the largest and most comprehensive individual patient data (IPD) meta-analysis to date on testicular metastases from renal cell carcinoma (RCC), with the aim of characterizing clinical features, quantifying survival outcomes, and identifying predictors of recurrence and mortality.
Methods: A systematic review was performed in April 2025 using PubMed, Scopus, Web of Science, and Google Scholar. Eligible studies included histologically confirmed testicular metastases from RCC with extractable patient-level data. Fifty-three cases from 40 articles were included. One unpublished case from our institution was included. We extracted demographics, pathology, treatment, imaging, and outcome data. Tumor volume was calculated from ultrasound dimensions using the ellipsoid formula. For bilateral metastases, the mean volume was used in regression analysis.
Results: The median overall survival was 17 months (interquartile ranges [IQR], 7.4-26), and progression-free survival was 9 months (IQR, 6-18.5). Lymph node metastasis (odds ratio [OR] = 15.7, P = .019) and presence of metastases at RCC diagnosis (OR = 6.5, P = .034) were associated with mortality. Synchronous metastases (OR = 38.5, P = .002) and lung involvement (OR = 28.0, P = .004) were predictors of recurrence. Survival differed significantly across Fuhrman grades (P = .032) and T stages (P = .047). In Cox regression, metastasis at diagnosis predicted shorter overall survival, while lung and lymph node involvement were the strongest predictors of recurrence.
Conclusion: This meta-analysis provides the first pooled survival estimates and prognostic modeling for testicular RCC metastases. Findings support the value of early detection and confirm the prognostic impact of synchronous disease and nodal spread. These results establish a foundation for clinical risk stratification and long-term surveillance strategies in affected patients.
期刊介绍：
Urology is a monthly, peer–reviewed journal primarily for urologists, residents, interns, nephrologists, and other specialists interested in urology
The mission of Urology®, the "Gold Journal," is to provide practical, timely, and relevant clinical and basic science information to physicians and researchers practicing the art of urology worldwide. Urology® publishes original articles relating to adult and pediatric clinical urology as well as to clinical and basic science research. Topics in Urology® include pediatrics, surgical oncology, radiology, pathology, erectile dysfunction, infertility, incontinence, transplantation, endourology, andrology, female urology, reconstructive surgery, and medical oncology, as well as relevant basic science issues. Special features include rapid communication of important timely issues, surgeon''s workshops, interesting case reports, surgical techniques, clinical and basic science review articles, guest editorials, letters to the editor, book reviews, and historical articles in urology.
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