Introduction: Survival of patients with testicular germ cell tumours has improved in recent years, mainly due to new modes of chemotherapy. We analyzed incidence, staging and survival of patients diagnosed during the last ten years in Iceland and compared the results to previous studies.

Materials and methods: A retrospective study including all Icelandic males diagnosed during 2000-2009. Pathology reports were reviewed and the tumours staged (Boden-Gibb). Overall survival was estimated and seminomas (ST) and non-seminomas (N-ST) compared.

Results: 97 males were diagnosed, age-adjusted incidence being 5.9/100.000 males per year. The number of ST and N-ST was almost equal, and the mean age was 35.6 (range; 15-36), but patients with ST were 11.5 years older compared to N-ST. Symptoms were similar in both groups, also tumor size (4.0 cm), which did not change during the study period. Most of the tumours were in stage I, or 78.4%, 13.4% were in stage II og 8.2% in stage III-IV. ST were diagnosed at a significantly lower stage compared to N-ST (91.7 versus 65.3% in stage I; p=0.003). No distant metastases were diagnosed in patients with ST but in 8 patients with N-ST. Four patients died during the study period, two due to N-ST but no patient died because of ST. Five-year survival for the whole patient group was 95.1%.

Conclusion: The incidence of testicular carcinoma in Iceland is similar to neighbouring countries and has remained fairly constant for the last two decades. At the same time the number of patients with localized disease (stage I) as well as the size of the tumours has not changed significantly. Survival in Iceland is comparable to the best results reported elsewhere.

Orrason AW, Agnarsson BA, Geirsson G, Helgason HH, Gudbjartsson

Testicular cancer in Iceland 2000-2009: Incidence and survival

Icel Med J 2011; 97: 143-8

Correspondence: Tómas Guðbjartsson, tomasgud@landspitali.is

Key words: Testicular germ cell tumours, seminoma, non-seminoma, incidence, survival, treatment.nd is comparable to the best results reported elsewhere.

Table I. Histological classification of testicular germ cell tumours in Iceland 2000-2009. Two thirds of the non-seminomas were mixed tumors. Number of patients and % in parenthesis.

Histological classification				Number (%)
Seminoma				48 (49.5)
Non-seminoma				49 (50.5)
	Mixed tumors			32 (33.0)
	Embryonal carcinoma			11 (11.3)
	Teratoma			6  (6.2)
	Choriocarcinoma			0 (0)
	Yolk sac tumour			0 (0)
Total				97 (100)

 

Table II.  Boden-Gibb staging of patients with seminomatous and non-seminomatous testicular carcinoma in Iceland 2000-2009. Number of patients and % in parenthesis.

Stage	Description	Seminoma n  (%)	Non-seminoma n (%)	Total
I	Tumor limited to testis	44 (91.7)	32 (65.3)	76 (78.4)
IIA	Retroperitoneal node metastasis < 5 cm	3 (6.2)	7 (14.3)	10 (10.3)
IIB	>5 cm	1 (2.1)	2 (4.1)	3 (3.1)
III	Supra-diaphragmatic nodal metastasis	0 (0)	1 (2.0)	1 (1.0)
IV	Extra nodal metastases	0 (0)	7 (14.3)	7 (7.2)
Total		48 (100)	49 (100)	97 (100)

Table III.  Boden-Gibb staging of patients with testicular carcinoma in Iceland 1970-2009. Three periods are compared; 1970-1977, 1978-1999 and 2000-2009. Figures for the first two periods were obtained from reference no. 9. Number of patients and % in parenthesis.

 

Stage	1970 - 1977 n (%)	1978 - 1999 n (%)	2000 - 2009 n (%)
I	12 (52.2)	103 (70.5)	76 (78.4)
IIA	5 (21.7)	21 (14.4)	10 (10.3)
IIB	2 (8.7)	10 (6.8)	3 (3.1)
III	0 (0)	4 (2.7)	1 (1.0)
IV	4 (17.4)	8 (5.4)	7 (7.2)
Total	23 (100)	146 (100)	97 (100)

Fig. 1.  Age-standardized incidence (per 100.000 males/year) of testicular cancer in Iceland between 1970 and 2009. Information on incidence rates between 1970 and 1999 was obtained from reference no. 9.

Fig. 2.  Age distribution of patients diagnosed with testicular cancer in Iceland 2000-2009. Patients with seminoma and non-seminoma are shown separately.

Fig. 3.  Overall survival for 97 males diagnosed with testicular carcinoma in Iceland 2000-2009. At follow-up (May 1, 2010) four patients had died, two of non-seminoma and none due to seminoma. Broken lines show 95% confidence interval.

Fig. 4.  Age-standardized incidence (per 100.000 males/year) of testicular cancer in the Nordic Countries  from 2000 to 2007. Information was obtained from reference no. 3.