Testiküler Kitleyle Başvuran Hastaların Demografik ve Klinik Verileri ve Genel Sağ Kalıma Etki Eden Faktörler

Amaç: Testiküler kitle ön tanısıyla radikal orşiektomi yapılmış hastalarda, başvuru anında testis kanseri ile ilgili genel bilgi ve farkındalık düzeyini, tedavi sonrası takibe uyum oranını ve bu bilincin oluşmasına etki edebilecek faktörleri değerlendirmeyi amaçladık. Gereç ve Yöntemler: Ocak 2010 - Haziran 2018 tarihleri arasında, testiküler kitle ön tanısıyla radikal orşiektomi yapılan 113 hastanın demografik, klinik, patolojik verileri ve onkolojik sonuçları retrospektif olarak değerlendirildi. Hastaların doktora başvuru nedenleri, kendisinde veya ailesinde testis kanseri öyküsü, doktora başvurmasına kendisini yönlendiren etken, başvuru öncesi ve tedavi sonrası takipte düzenli olarak kendi kendine testis muayenesi yapma oranları kaydedildi. Bulgular: Ortanca yaşı 29 (17-60) olan 113 hastada, en sık başvuru nedenleri; ağrısız kitle, sertlik (%52.4), şişlik (%10.6), kendisinde (%6.2) ve ailesinde (%7.1) testis kanseri öyküsü, eşinin yönlendirmesi (%6.2) olarak bulundu. Testis kanseri hakkında genel bilgisi olanlarda üniversite mezunlarında, gelir düzeyi düşük olmayanlarda, evli bireylerde, kendisinde veya ailesinde testis kanseri öyküsü olanlarda, düzenli olarak kendi kendine testis muayenesi yapanlarda daha yüksek oranda erken evre testiküler germ hücreli tümör veya benign doku patolojisi saptandı. Kişide (HR: 1.845, p=0.015) ve ailesinde (HR: 1.756, p=0.036) testis kanseri öyküsü, inmemiş testis öyküsü (HR:2.561, p=0.026), düşük eğitim seviyesi (HR: 1.012, p=0.034), düşük gelir düzeyi (HR:1.003, p=0.041), evli olmamak (HR: 2.879, p=0.037), daha önceden testis kanseri hakkında genel bilgi sahibi olmamak (HR: 4.204, p=0.032), tanı öncesinde (HR:6.247, p=0.037) ve tedavi sonrası takip döneminde düzenli olarak kendi kendine testis muayenesi yapmamak (HR:2.015, p=0.032), tedavi sonrası takip sürecini aksatmak (HR:1.121, p=0.024), ileri tümör evresi (HR:1.104, p=0.005) genel sağkalımı azaltan bağımsız risk faktörleri olarak saptandı. Sonuç: Bireyin kendisine veya ailesine ait geçirilmiş testis kanseri varlığının, çeşitli toplumsal haber araçlarının, yüksek eğitim düzeyinin, eş farkındalığının erkeklerin testis kanseri konusunda daha fazla bilinçlenmesini sağlayabileceğini düşünmekteyiz. Bu sayede gerek erken evrede saptanan tümör oranları artacağı için daha az toksik tedaviler uygulanabilecek, gerekse de daha iyi onkolojik sonuçlar sağlanabilecektir.

Anahtar Kelimeler:

eş farkındalığı, kendi kendine testis muayenesi, radikal orşiektomi, testis kanseri, Erkek farkındalığı, genel sağkalım, testiküler kitle

Demographic and Clinical Data of Patients Presenting With Testicular Mass and Factors Affecting Overall Survival

Objective: We aimed to evaluate the general knowledge and awareness of the patients about testicular cancer at admission,their adherence to follow-up period after the treatment and the factors that may affect this awareness in the patients who underwent radical orchiectomy due to diagnosis of testicular mass. We aimed to evaluate the factors that may affect overall survival by examining the complaints, demographic and clinical features of patients who underwent radical orchiectomy with a pre-diagnosis of testicular mass.Material and Methods: Between January 2010 and June 2018,demographic,clinical, pathological data and oncologic outcomes of 113 patients who underwent radical orchiectomy with a diagnosis of testicular mass were evaluated retrospectively.Reasons for admission to the doctor,the history of testicular canc er in himself and his relatives,the factors that led him to refer to the doctor, the rates of regular testicular self-examination during the pre-treatment and post-treatment period were recorded.Results: In 113 patients with a median age of 29 (ranged 17-60),the most common complaints were painless mass (%52.4), swelling (%10.6), history of testicular cancer in himself (%6.2) and his relatives (%7.1), his wife’s warning (%6.2).The patients having general knowledge about testicular cancer, university graduates, patients with enough income level, married individuals, patients with history of testicular cancer in himself and his relatives, performing regular testicular self-examination had the higher rates of early stage testicular germ cell tumor or benign pathology.History of testicular cancer in himself and his relatives,history of undescended testicle,low educational level,low income level,not to be married,no prior knowledge of testicular cancer,not performing regular testicular self-examination before diagnosis and during the follow-up period,advanced tumor stage, disrupt follow-up after treatment were found to be independent risk factors for decreased overall survival.Conclusion: We think that the history of testicular cancer, various social communication tools, higher education level and spouse awareness may increase the awareness of men about testicular cancer the likelihood of testicular masses’ being detected earlier.In this way, less toxic treatments can be administered since the increased tumor rates detected in the early stage, and also better oncologic outcomes can be achieved.

Keywords:

Male awareness, Overall survival, radical orchiectomy, spouse awareness, testicular mass, testicular self-examination,

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1. McGlynn KA, Cook MB. Etiologic factors in testicular germ-cell tumors. Future Oncol 2009;5:1389-402.
2. Siegel RL, Miller KD, Jemal A. Cancer statistics. Cancer J Clin 2017;67:7–30.
3. Laguna MP, Albers P, Albrecht W, et al. European Association of Urology guidelines on testicular cancer: the 2019 Update. ISBN 978-94-92671-04-2. EAU Guidelines Office, Arnhem, The Netherlands. Available from: https://uroweb.org/guideline/testicular-cancer/
4. Stephenson AJ, Gilligan TD. Neoplasms of the Testis. In: Campbell Walsh Urology 11th Edition. Philadelphia: Elsevier; 2016. p. 784-814.
5. Kuzgunbay B. The Status of Testicular Self-Examination in the Early Diagnosis of Testicular Cancer: Conjuncture in the World and in Turkey. Bull Urooncol 2014;13:127-9.
6. Casey RG, Grainger R, Butler MR, et al. Public awareness of testis cancer and the prevalence of testicular self-examination-changing patterns over 20 years. Urology 2010;76:915– 8.
7. Kuzgunbay B, Yaycioglu O, Soyupak B, et al. Public awareness of testicular cancer and self-examination in Turkey: a multicenter study of Turkish Urooncology Society. Urol Oncol 2013;31:386-91.
8. Ugboma HA, Aburoma HL. Public awareness of testicular cancer and testicular self-examination in academic environments: a lost opportunity. Clinics (Sao Paulo) 2011;66:1125-8.
9. Westlake SJ, Frank JW. Testicular self-examination: An argument against routine teaching. J Fam Pract 1987;4:143–8.
10. Khadra A, Oakeshott P. Pilot study of testicular cancer awareness and testicular self examination in men attending two South London general practices. Fam Pract 2002;19:294–6.
11. Brenner JS, Hergenroeder AC, Kozinetz CA, Kelder SH. Teaching testicular self-examination: Education and pratices in pediatric residents. Pediatrics 2003;111:239-44.
12. Speir RW, Cary C, Masterson TA.Surgical salvage in patients with advanced testicular cancer: indications, risks and outcomes. Transl Androl Urol. 2020;9(Suppl 1):S83-S90.
13. Wang X, Tu X, Tan P, et al. Adult genitourinary sarcoma: Clinical characteristics and survival in a series of patients treated at a highvolume institution. Int J Urol 2017;24:425-431.
14. Wardle J, Steptoe A, Burckhardt R, et al. Testicular self-examination: Attitudes and practices among young men in Europe. Prev Med 1994;23:206-10.
15. Katz RC, Meyers K, Walls J. Cancer awareness and self-examination practices in young men and women. J Behav Med 1995;18:377– 84.
16. Sirin A, Atan Unsal S, Tasci E. Protection from cancer and early diagnosis applications in Izmir, Turkey. Cancer Nurs 2006;29:207–13.
17. Ugurlu Z, Akkuzu G, Karahan A, et al. Testicular cancer awareness and testicular self-examination among university students. Asian Pac J Cancer Prev 2011;12:695-8.
18. Özbaş A, Çavdar İ, Findik ÜY, Akyüz N. Inadequate knowledge levels of Turkish male university students about testicularself-examination. Asian Pac J Cancer Prev 2011;12:919-22.
19. Mani J, Kloft J, Jones J, et al. Awareness of clinical relevance of malignant testicular cancer among university students: The value of prevention campaigns. Urologe A 2019;58(7):790-4.
20. Braga IC, Cabral J, Louro N, de Carvalho JL. Testicular Cancer Awareness and Knowledge: Is It the Same? Exploratory Study in a Mixed-Gender Population. J Cancer Educ 2017;32(1):105-11.
21. Saab MM, Landers M, Hegarty J. Promoting Testicular Cancer Awareness and Screening: A Systematic Review of Interventions. Cancer Nurs. 2016;39(6):473-87.