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American Journal of  
Life Science and Innovation (AJLSI)

Demographics and Outcomes of  Testicular Tumors in Patients Treated at King Faisal 
Specialist Hospital and Research Centre, Riyadh 

Sultan Saud Alkhateeb1*, Majed Alrumayyan1, Mohammed Faihan Alotaibi1 

Volume 3 Issue 2, Year 2024
ISSN: 2833-1397 (Online)

DOI: https://doi.org/10.54536/ajlsi.v3i2.3081
https://journals.e-palli.com/home/index.php/ajlsi

Article Information ABSTRACT

Received: June 02, 2024

Accepted: July 12, 2024

Published: November 21, 2024

Testicular cancer is a relatively rare but significant malignancy, primarily affecting males 
between the ages of  15 and 35. The incidence and epidemiological patterns of  testicular 
cancer vary across different geographic regions. This study aims to describe the 
demographics and outcomes of  testicular tumors in patients treated in a tertiary setting at 
King Faisal Specialist Hospital and Research Centre in Riyadh.  This retrospective cohort 
study was conducted at King Faisal Specialist Hospital and Research Centre (KFSHRC), 
focusing on patients across various regions in the kingdom from 2000 to 2017. The research 
offers a comprehensive retrospective analysis. The records of  125 males diagnosed and 
treated with testicular cancers with an age bracket of  14-35 years were examined. It was 
observed that males aged 26-35 showed the highest rate of  incidence of  testicular cancer. 
The primary differences between the progression of  seminomas and nonseminomas are 
explored, with the latter comprising diverse subtypes such as yolk sac tumors, teratomas, 
embryonal carcinomas, and choriocarcinomas. This research studied patient demographics, 
clinical presentations, histopathological patterns, treatment modalities, and associated 
complications. Apart from stage 3 cases, the present research found consistency in survival 
outcomes, recurrence rates, and risk variables across locations. This retrospective cohort 
study challenges long-held beliefs and offers new insight into the treatment and prognosis 
of  patients with testicular cancer at the KFSHRC. This study is significant because it has the 
potential to influence future methods of  treating testicular cancer and advance knowledge 
of  the subtleties and regional variations of  the illness, which is beneficial for both patients 
and healthcare professionals.

Keywords

Demographic Analysis, Imaging, 
Orchiectomy, Pathology, 
Testicular Cancer, Testicular 
Tumor, Undescended Testicles

1 Department of  Urology, King Faisal Specialist Hospital and Research Centre and College of  Medicine, Alfaisal University, Riyadh,  
  Saudi Arabia
* Corresponding author’s e-mail: alkhateeb656@outlook.com

INTRODUCTION
Testicular germ cell tumors are the most common types 
of  testicular cancers and contribute to a total of  90% 
of  testes cancer (Bahrami et al., 2007). Testicular tumors 
account for only 1% of  all cancers in men and around 
5% of  all urological cancers (Siegel et al., 2018). Testicular 
cancers normally occur in patients with ages ranging from 
15 years to 35 years.
The incidence and epidemiological patterns of  testicular 
cancer vary across different geographic regions. American 
Cancer Society (ACS) has reported that 9910 newly 
diagnosed patients of  testicular tumors in the year 2022, 
out of  which 460 are residents of  the USA (Alghamdi, 
2023). The International Agency for Research on Cancer 
(IARC) has reported s that the age-standardized incident 
rate for testicular cancer in men in Saudi Arabia is around 
0.8 cases per 100,000 people (S, 2007).
Nearly 440 deaths were predicted to occur due to testicular 
cancer in the USA, with a survival rate as high as 95% and 
five years of  lifespan in the year 2017 (Gilligan et al., 2019). 
The frequency of  prevalence of  testicular cancer is highly 
dependent on the geographic locations of  susceptible 
cases (Huyghe et al., 2003). European countries have 
shown the highest age-standardized incident rates, up to 
6.3% (Shanmugalingam et al., 2013). Notably, regions of  
the USA, such as North American countries, have also 
given significant age-standardized incident rates of  about 
5.1%, and Latin America and the Caribbean have incident 

rates of  4.4% (Nigam et al., 2015). In comparison, Asian 
and African countries have the lowest age-standardized 
incident rates of  0.77% and 0.34% (Wang et al., 2021).
The incidence of  Germ Cell Tumors appears to be 
increasing worldwide. In the United States, the age-
dependent prevalence frequency for puberty hitting 
boys and men 15 to 49 years old accelerated from 
2.5 to 5.1 per 100000 people in the year 2004 (Bleyer, 
2007). Meanwhile, the growth rate of  seminomas was 
exponential concerning seminomas germ cell tumors. 
The focused study aims to fulfill the research gap that 
proves that there is comparatively limited data available 
on the prevalence of  testicular cancer in Saudi Arabia. 
The present retrospective cohort study aimed to perform 
an extensive analysis of  testicular tumors in residents 
of  Saudi Arabia whom King Faisal Specialist Hospital 
and Research Centre have treated. The present research 
examined incidence rate, prevalence trends, patient 
management and its outcomes, and the progression-free 
survival of  patients.

MATERIALS AND METHODS
Study Design and Setting
The study is a retrospective cohort study of  pre-existing 
data. All participants of  this study are patients who were 
diagnosed or had received treatment for a testicular 
tumor in the King Faisal Specialist Hospital & Research 



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Center (KFSHRC). The retrospective cohort study covers 
multiple clinical aspects, including histological types of  
the tumor, the staging of  the cancer, and the mode of  
treatments employed for those cases that were treated. 
The current study has also included radiographic imaging 
of  the tumor and tumor markers. Case records that were 
incomplete or lacked essential data were excluded. Only 
those patients who were residents of  Saudi Arabia and 
were diagnosed and treated at King Faisal Specialist 
Hospital & Research Center (KFSHRC) were included in 
the study.

Participants 
The study included a total of  125 patients; all the patients 
underwent orchiectomy surgery as a treatment. The 
participants were categorized as one main group and had 
four sub-groups. The main group comprises residents of  
Riyadh and those living outside Riyadh.
Our study included 1 main group and 4 subgroups. The 
main group compared patients living in Riyadh with those 
residing outside Riyadh. The sub-groups are formed 
based on the recurrence of  cancer, the pathology type of  
cancer, the progression or the risk factor of  the tumors, 
and the stage of  the tumors.

Data source and variables
The medical records of  patients, including the 
demographic data and all the data regarding the 
pathological type of  tumors, the rate of  recurrence of  
the tumors, and the progression of  the disease, were 
retrieved from the reported data of  the Research Centre. 
The symptoms and their appearances, the treatment 
procedure and their impacts, and the progression-free 
survival rate were directly obtained from the clinical data 
present in the repository of  the research center. The 
factors used to narrow down the data included the age 
of  patients, who were classified into sub-groups; patients 
aged 25-65 were included. The demographic data was also 
categorized into subgroups of  patients living in Riyadh 
and outside Riyadh. Data from patients across different 
kingdom regions with testicular cancer treated at King 
Faisal Specialist Hospital & Research Center (KFSHRC) 
were analyzed to study the pattern of  testicular tumors 
and management outcomes in tertiary care hospitals in 
many regions of  Saudi Arabia.

Data Analysis
The Kaplan-Meier method was applied to calculate 
survival curves, and the log-rank test was used to 
compare them. All the statistical data were studied using 
SPSS version 13.0 (SPSS Inc.Chicago, IL, US), and the 
standard deviation were calculated for the demographic 
characters of  the population. The two-tailed unpaired or 
paired Student’s t-test was used to determine the statistical 
variation between the sub-groups. 

Statistical Considerations
The study’s main goal was the rate of  cancer-specific 
survival (CSS), calculated by the interval between the 

moment surgery is completed and the time of  death or last 
follow-up. Another critical parameter of  the research was 
recurrence-free survival (RFS), calculated by studying the 
interval between the surgery date and tumor recurrence. 
The third main parameter of  the study, called Overall 
survival (OS), was calculated from the period of  surgery 
to the time of  mortality. The fourth parameter analyzed 
was the Thirty-day mortality. It represents any death that 
happened within 30 days after radical orchiectomy. The P 
values P < 0.05  for all tests were considered significant.

Ethical Considerations
Ethical approval was taken from the hospital’s Institutional 
Review Board (IRB). Ensuring anonymity and secrecy 
is the top concern when discussing and publishing our 
results. Participants’ private information is kept private, 
protecting their right to privacy and following the 
protocol according to ethical guidelines.

RESULTS AND DISCUSSIONS
Analysis of  Survival Curve Analysis
The study used a chi-square homogeneity test to find the 
difference between the survival rate of  patients living in 
Riyadh and those residing outside Riyadh. The relation 
between these variables was non-significant 1, X2 (1, N 
= 125) = 0.97, p=0.32, and the survival curve showed 
no difference in overall survival. Nonetheless, there was a 
difference in survival between seminoma and NSGT; the 
test was marginally significant at X2 (1, N = 125) = 3.14, 
p=0.07. Moreover, the overall survival between patients 
with undescended and normal testis showed no difference, 
and the test was not significant X2 (1, N = 125) = 0.25, 
p=0.6. Finally, survival rate by stage presentation showed 
no difference in the overall testicular cancer stage groups 
1A-2C presentation except for group 3, which had the 
worst prognosis, and the test was marginally significant 
X2 (6, N = 125) = 11.68, p=0.06. 

Patients Characteristics
The present research included a total of  125 patients 
who were diagnosed and treated at King Faisal Specialist 
Hospital & Research Center (KFSHRC) between 2010-
2017. All these patients suffered from two different 
pathologies, including non-seminomatous germ cell 
tumors (NSGCT) and seminomatous germ cell tumors. 
Patient characteristics are shown in the figures below. The 
median age was 33 (range: 28–40 yr). Figure 1 shows that 
the highest ratio of  patients affected by testicular cancer 
lies in the age bracket of  26-35 years. One reason behind 
this could be the presence of  seminomatous germ cell 
tumors, which commonly affect men in their thirties and 
above. The second highest number of  patients noted 
was 0-25 years old; these patients are more likely to be 
affected by non-seminomatous germ cell tumors. 9.60% 
of  patients were 46-55, while patients in their late fifties 
and early sixties constituted only 4%. Patients in their late 
sixties were countable as they accounted for less than 1% 
of  the whole selected population.



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Figure 1: Age ratio of  patients affected by testicular 
cancer.
Types of  Pathologies
Seventy-three out of  a total of  125 patients were affected 
by non-seminomatous germ cell tumors (NSGCT). Of  
those 73 patients, nearly 54 were affected by mixed germ 

cell tumors. It was also seen that almost 52 recorded cases 
were affected by seminomas. The line graph in Figure 3 
shows the survival probability of  patients affected by 
the non-seminomatous germ cell tumor (NSGCT) and 
seminomatous germ cell tumor. Seminoma survival rates 
are higher than other testicular germ cell tumor forms, as 
indicated by the curve representing this tumor type. The 
high survival rate for seminomas is because, compared to 
other forms of  testicular germ cell tumors, seminomas 
usually show less aggressive behavior. The survival 
probability declines with time, as seen by the curves 
for each of  the three groups. The decline in survival 
probability is because some cancer patients still pass away 
after receiving treatment. The degree of  overall survival 
decreases over time. Figure 2 shows an examination of  
survival curves reveals a noteworthy distinction in overall 
survival between seminoma and other germ cell cancers.

Demographic characteristics

Figure 2: Survival curves between seminoma and other germ cell cancers.

Analysis of  patients’ demographic data showed that 
nearly 50% of  included patients were residents of  Riyadh. 
Almost 12% belonged to the northern province, while 
nearly 10% of  the cases were reported from the eastern 
province. Jawf  and Tabuk showed the lowest cases, 
i.e., only 0.8%. Figure 4 depicts a difference in survival 
between the two groups: the group living in Riyadh has 
a higher probability of  survival than those living in other 
regions. This high survival probability could be due to 
several factors, such as healthcare access or lifestyle 
differences. The likelihood of  survival is high in the first 
few years following surgery, but it then starts to decline. 
According to the survival curve study, figure 3 shows 
no overall survival difference between Riyadh and other 
places.
Most patients, i.e., 29.6% included patients, were diagnosed 
and treated at stage 1A, and 8.8% were diagnosed at stage. 

At stage 3, the worst progression was seen, and nearly 
25.6% patients of  total patients suffered through it. This 
worst progression can be due to the aggressive nature 
of  non-seminomatous germ cell tumors (NSGCT). At 
the end of  the study, 6(4.8%) patients had recurrence, 
4(3.2%) passed away due to disease, and 115(92%) were 
in remission.

Risk Factor- cryptorchidism
In the case of  patients with testicular cancer, undescended 
testis appeared to be a prominent risk factor. The graph 
in Figure 5 shows that the probability of  survival is lower 
for people who have been affected by an undescended 
testis condition than for people who have not been 
exposed to any such risk factor. Patients with any history 
of  undescended testis are likely to develop testicular 
cancer. Figure 5 shows no discernible difference in overall 



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Figure 3: survival difference between Riyadh and other places

Figure 4: Stage Presentation of  tumor

Figure 5: Survival curve analysis shows no significant 
difference in overall survival between patients with 
descending testicles and those without.

survival between patients with descending testicles and 
those without, according to survival curve analysis.

Discussion
Testicular cancer is a malignant tumor associated with 
the testicles, which are the primary components of  the 
male genitals. Testicles are primarily responsible for the 

production of  sperm; they also regulate hormonal balance 
as they are responsible for the release of  testosterone. 
Testicular cancer usually occurs between the ages of  15 
and 35. Testicular cancer is common in young men, and it 
can be easily diagnosed by self-examination of  the testicles 
and the tumor can be cured by surgery if  diagnosed early 
(Altunkurek, 2020). The degree of  incidence of  testicular 
cancer highly depends upon factors such as demographic 
locations, age, multiple types of  pathology, and congenital 
disabilities such as cryptorchidism, which act as major 
risk factors (Yazici et al., 2023).
The reported cases of  testicular cancers globally are 
approximately 78400, making it the 20th most prevalent 
cancer (Safiri et al., 2023). Testicular cancer showed an 
interesting trend in terms of  demographic locations; 
it was seen that more than 62 nations worldwide were 
affected (Bray et al., 2013), with the highest rate in West, 
North, and South Europe, Oceania, and North America. 
The continents that are less developed, such as Asia and 
Africa, showed the lowest rate (Giona, 2022). The rate of  
incidence of  testicular cancer in Saudi Arabia has been 
accelerated in the last decades (Abomelha, 2017). As 
per the Saudi Cancer Registry (SCR), in 2017, the total 
reported cases reached the figure of  8850 new cases, and 
the death toll reached an approximate number of  410 
(Baird et al., 2018). In Europe, the survival rate shown by 
testicular cancer is 95% per person, which to date is the 
highest recorded survival rate for any cancer occurring in 
men (Znaor et al., 2020).
There are many risk factors contributing to testicular 
cancer in men, such as smoking, undescended testis, 
family history, and infertility. The major risk posing 
factor is cryptorchidism, or the condition of  having an 
undescended testicle. Patients with this condition are 
more likely to get testicular cancer compared to others 
(Ergül et al., 2024). Patients having genetic conditions 
such as Klinefelter syndrome can raise a person’s chance 



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of  acquiring testicular cancer (Swerdlow et al., 2006). In 
case of  genetic mutation such as those in the KITLG 
gene also increases the risk of  developing testicular 
cancer (Pyle et al., 2024). It can relapse in men who have 
been affected previously by testicular cancer in either 
testicle. The study has shown that the age bracket mostly 
affected by testicular cancer ranges from 15-35, so men at 
this age are most prone (Franco et al., 2023). One of  the 
main reasons why European and American nations have 
shown the highest rate of  incidence for testicular cancer 
is the fact that white men are more prone to this cancer 
compared to other ethnicities (Ghazarian et al., 2015). 
Environmental factors also play a role in the prevalence 
of  testicular cancer. Studies have shown that exposure to 
toxins such as endocrine-disrupting chemicals (EDCs) 
during pregnancy and the early stages of  life increases 
the risk factor of  acquiring testicular cancer (Cannarella 
et al., 2023). 
Seminomas and nonseminomas (NSGCTs) are the 
primary germ cell tumors, accounting for most testicular 
malignancies. Because NSGCTs grow more quickly 
and are generally more aggressive, postoperative care 
is frequently needed (Siddiqui et al., 2020). Seminomas 
may not require further procedures since they grow 
more slowly and are less aggressive  (Bray et al., 2006). 
To diagnose and treat both, the first step is usually 
orchiectomy (testicle removal). Orchiectomy is a surgical 
method and is known as the gold standard for treating 
testicular cancer. Post-orchiectomy treatment plans are 
tailored for the specific stage of  the tumor identified after 
surgery (Stephenson et al., 2019). 
Our study assessed the survival rate regarding disease 
recurrence, pathology type, patients with risk factors, 
and stage presentation between patients living in Riyadh, 
treated at KFSHRC, and patients from different kingdom 
regions. We retrospectively went through our patient’s 
records from 2010-2017. Subsequently, our follow-up 
with the patients post-orchiectomy included radiological 
images and tumor markers (Chavarriaga et al., 2023). The 
study showed that the frequency of  incidence of  testicular 
cancer showed a significant relation with the age of  the 
patients, as most of  the studied patients were in the age 
group of  26-35 years. 
Our retrospective cohort study found no statistically 
significant variations in overall survival between patients 
residing in and outside of  Riyadh, indicating that 
geographic location may not be a relevant factor in the 
prognosis of  seminoma and nonseminoma germ cell 
tumors (GCTs). Furthermore, the assessed risk factors 
affected neither the seminoma nor the NSGCT groups’ 
overall survival. The results revealed that patients with 
pure seminomas had improved overall survival rates 
than those with pure NSGCTs, which suggests that 
nonseminoma variations were naturally more aggressive 
(Fero et al., 2021). Stage 3 presentations showed noticeably 
worse survival rates, underscoring the significance of  early 
discovery and care, while Stage 1A–2C GCTs showed 
similar survival outcomes (Abdul-Muhsin et al., 2021). 

One of  the main reasons no significant difference was 
seen in patients living inside Riyadh and receiving the best 
treatment at King Faisal Specialist Hospital & Research 
Center (KFSHRC) and outside Riyadh is that patients 
across the kingdom were able to receive timely diagnosis 
and treatment. The lack of  correlation between the risk 
factors under study and survival highlights the need for 
more research into more comprehensive risk profiles that 
affect the progression of  tumors. Another explanation is 
that risk factors mentioned in the study are not associated 
with a worse prognosis. Therefore, neither the treatment 
regimen nor the follow-up should be changed for patients 
with testicular cancer and for patients who have risk 
factors. Furthermore, our findings converge with previous 
studies showing that seminoma had better survival overall 
than NSGCT. At the end of  the study, out of  125 patients, 
115(92%) were in remission, 4 passed away and 6 had 
recurrence. These findings show that testicular cancer has 
a good prognosis if  treated properly (Cassell et al., 2020). 
Our finding that pure seminomas have a higher survival 
rate than NSGCTs corresponds with previous studies and 
highlights the intrinsic aggressiveness of  nonseminoma 
variations. This knowledge can inform strategies for 
targeted treatment and risk stratification. 
In our tumors staging sub-group, it was seen that group 
2C had 4 patients only, making the results significant. 
Although our study was conducted at KFSHRC, we did 
not limit ourselves to the samples of  patients treated at 
KFSHRC only; we included patients from other tertiary 
hospitals across the kingdom. The number of  testicular 
cancer patients in the kingdom has been rising recently; 
during our study, we analyzed 125 cases from 2010 to 
2017. Even though our sample size is small compared to 
the entire population, it can still serve as a starting point 
for more extensive research that can be carried out soon.
As per our best knowledge and extensive research, we can 
surely state that there is not enough research conducted 
in Saudi Arabia on testicular cancer. We selected King 
Faisal Specialist Hospital & Research Center (KFSHRC) 
as our referral hospital because it is the primary national 
referral cancer center, receiving about 22% of  all cancer 
cases nationwide. Our results provide new insight into 
the KFSHRC’s strategy regarding the pattern of  tumor 
progression and treatment outcomes for patients with 
testicular cancer. Furthermore, this will contribute to 
the body of  knowledge regarding the management and 
surveillance of  testicular cancer, namely GCTs, in Saudi 
Arabia.

Future Directions
Despite the sample size constraints, the study establishes 
the foundation for additional research on testicular cancer 
in Saudi Arabia. We must evaluate risk profiles more 
extensively, as the study indicates that some risk factors 
and survival are unrelated. Understanding the intrinsic 
aggressiveness of  nonseminoma variants should be 
useful in developing strategies for focused treatment and 
risk classification. Research on tumor progression and 



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treatment outcomes is essential as the number of  instances 
of  testicular cancer in the kingdom rises. The correlations 
between various parameters reviewed in this retrospective 
provide light on trends and results at a national referral 
center, which helps with the care and surveillance of  
testicular cancer in Saudi Arabia, particularly germ cell 
tumors. Additional comprehensive study is necessary 
to enhance comprehension and direct advancements in 
diagnosis, therapy, and patient management.

CONCLUSION
This retrospective research challenges geographical 
assumptions regarding testicular cancer in Riyadh and 
surrounding areas. No significant differences in stage 
were found between Riyadh and residents living outside 
Riyadh. It also revealed that factors such as genetics, 
smoking, and family history did not affect survival in 
seminoma or nonseminoma germ cell tumors. Seminoma 
showed a higher overall survival, indicating differences 
in treatment response. It is important to detect testicular 
cancer early, as Stage 3 presentations correlated with the 
lowest survival. Although this study was conducted in 
Riyadh, future research should involve diverse tertiary 
care facilities nationwide. Finally, this study challenges 
geographical assumptions and opens avenues for 
improving testicular cancer treatment strategies. 

REFERENCES
Abdul-Muhsin, H., Rocco, N., Navaratnam, A., Woods, 

M., L’Esperance, J., Castle, E., & Stroup, S. (2021). 
Outcomes of  post-chemotherapy robot-assisted 
retroperitoneal lymph node dissection in testicular 
cancer: multi-institutional study. World Journal of  
Urology, 39, 3833-3838. 

Abomelha, M. (2017). Adult testicular cancer: Two 
decades of  Saudi national data. Urology Annals, 9(4), 
305-309. 

Alghamdi, I. G. (2023). Testicular Cancer in Saudi Arabia 
Between 2004 and 2017. Research and Reports in Urology, 
37-45. 

Altunkurek, S. Z. (2020). Testicular cancer and the 
importance of  early diagnosis. Male Reproductive 
Health, 115. 

Bahrami, A., Ro, J. Y., & Ayala, A. G. (2007). An overview 
of  testicular germ cell tumors. Archives of  pathology & 
laboratory medicine, 131(8), 1267-1280. 

Baird, D. C., Meyers, G. J., & Hu, J. S. (2018). Testicular 
cancer: diagnosis and treatment. American family 
physician, 97(4), 261-268. 

Bleyer, A. (2007). Young adult oncology: the patients 
and their survival challenges. CA: a cancer journal for 
clinicians, 57(4), 242-255. 

Bray, F., Ferlay, J., Devesa, S. S., McGlynn, K. A., & Møller, 
H. (2006). Interpreting the international trends in 
testicular seminoma and nonseminoma incidence. 
Nature clinical practice Urology, 3(10), 532-543. 

Bray, F., Ren, J. S., Masuyer, E., & Ferlay, J. (2013). Global 
estimates of  cancer prevalence for 27 sites in the 

adult population in 2008. International journal of  cancer, 
132(5), 1133-1145. 

Cannarella, R., Gül, M., Rambhatla, A., & Agarwal, A. 
(2023). Temporal decline of  sperm concentration: 
role of  endocrine disruptors. Endocrine, 79(1), 1-16. 

Cassell, A., Jalloh, M., Ndoye, M., Yunusa, B., Mbodji, M., 
Diallo, A., Gaye, O., Labou, I., Niang, L., & Gueye, 
S. (2020). Review of  testicular tumor: diagnostic 
approach and management outcome in Africa. 
Research and Reports in Urology, 35-42. 

Chavarriaga, J., Bobrowski, A., & Hamilton, R. J. (2023). 
Guideline of  guidelines: follow up after orchidectomy 
for clinical stage 1 testicular cancer. BJU international, 
132(5), 485-495. 

Ergül, R. B., Bayramoğlu, Z., Keçeli, A. M., & Dönmez, 
M. İ. (2024). Risk for testicular germ cell tumors and 
spermatogenesis failure in post-pubertal undescended 
testes. International Urology and Nephrology, 1-6. 

Fero, K. E., Lec, P. M., Sharma, V., Lenis, A. T., Low, 
J., Litwin, M. S., Leapman, M. S., & Chamie, K. 
(2021). When is a Seminoma not a Seminoma? The 
Incidence, Risk Factors and Management of  Patients 
With Testicular Seminoma With Discordant Elevated 
Serum Alpha-fetoprotein. Urology, 157, 188-196. 

Franco, A. P. D. S., Lima Figueiredo, E. R., Melo, G. S., 
Souza, J. D. S. E., Gonçalves, N. V., Gomes, F. D. C., 
& Neto, J. S. D. M. (2023). Predictors of  testicular 
cancer mortality in Brazil: A 20-year ecological study. 
Cancers, 15(16), 4149. 

Ghazarian, A. A., Trabert, B., Devesa, S. S., & McGlynn, 
K. A. (2015). Recent trends in the incidence of  
testicular germ cell tumors in the United States. 
Andrology, 3(1), 13-18. 

Gilligan, T., Lin, D. W., Aggarwal, R., Chism, D., Cost, 
N., Derweesh, I. H., Emamekhoo, H., Feldman, 
D. R., Geynisman, D. M., & Hancock, S. L. (2019). 
Testicular cancer, version 2.2020, NCCN clinical 
practice guidelines in oncology. Journal of  the National 
Comprehensive Cancer Network, 17(12), 1529-1554. 

Giona, S. (2022). The epidemiology of  testicular cancer. 
Exon Publications, 107-116. 

Huyghe, E., Matsuda, T., & Thonneau, P. (2003). 
Increasing incidence of  testicular cancer worldwide: a 
review. The Journal of  urology, 170(1), 5-11. 

Nigam, M., Aschebrook-Kilfoy, B., Shikanov, S., & 
Eggener, S. (2015). Increasing incidence of  testicular 
cancer in the United States and Europe between 1992 
and 2009. World Journal of  Urology, 33, 623-631. 

Pyle, L. C., Kim, J., Bradfield, J., Damrauer, S. 
M., D’Andrea, K., Einhorn, L. H., Godse, R., 
Hakonarson, H., Kanetsky, P. A., & Kember, R. L. 
(2024). Germline exome sequencing for men with 
testicular germ cell tumor reveals coding defects 
in chromosomal segregation and protein-targeting 
genes. European urology, 85(4), 337-345. 

S., E. (2007). Cancer Incidence and Survival Report Saudi 
Arabia. 

Safiri, S., Hassanzadeh, K., Janbaz Alamdary, S., Mousavi, 



Pa
ge

 
63

https://journals.e-palli.com/home/index.php/ajlsi

Am. J. Life Sci. Innov. 3(2) 57-63, 2024

S. E., Nejadghaderi, S. A., Sullman, M. J., Naghdi-
Sedeh, N., & Kolahi, A.-A. (2023). The burden of  
testicular cancer from 1990 to 2019 in the Middle 
East and North Africa region. Frontiers in Oncology, 13, 
1276965. 

Shanmugalingam, T., Soultati, A., Chowdhury, S., 
Rudman, S., & Van Hemelrijck, M. (2013). Global 
incidence and outcome of  testicular cancer. Clinical 
epidemiology, 417-427. 

Siddiqui, B. A., Zhang, M., Pisters, L. L., & Tu, S.-M. (2020). 
Systemic therapy for primary and extragonadal germ 
cell tumors: prognosis and nuances of  treatment. 
Translational andrology and urology, 9(Suppl 1), S56. 

Siegel, R. L., Miller, K. D., & Jemal, A. (2018). Cancer 
statistics, 2018. CA: a cancer journal for clinicians, 68(1), 
7-30. 

Stephenson, A., Eggener, S. E., Bass, E. B., Chelnick, D. 
M., Daneshmand, S., Feldman, D., Gilligan, T., Karam, 
J. A., Leibovich, B., & Liauw, S. L. (2019). Diagnosis 
and treatment of  early stage testicular cancer: AUA 
guideline. The Journal of  urology, 202(2), 272-281. 

Swerdlow, A., Schoemaker, M., Higgins, C., Wright, A., 
Jacobs, P., & Group, U. C. C. (2006). Cancer Incidence 
and Mortality in Men With Klinefelter Syndrome: A 
Cohort Study. The Journal of  urology, 175(4), 1364-1365. 

Wang, S.-C., Chang, N.-W., Chen, W.-J., Yang, M.-
H., Chen, S.-L., & Sung, W.-W. (2021). Trends of  
testicular cancer mortality-to-incidence ratios in 
relation to health expenditure: An ecological study 
of  54 countries. International journal of  environmental 
research and public health, 18(4), 1546. 

Yazici, S., Del Biondo, D., Napodano, G., Grillo, M., 
Calace, F. P., Prezioso, D., Crocetto, F., & Barone, B. 
(2023). Risk factors for testicular cancer: environment, 
genes and infections—is it all? Medicina, 59(4), 724. 

Znaor, A., Skakkebæk, N. E., Rajpert De Meyts, E., 
Laversanne, M., Kuliš, T., Gurney, J., Sarfati, D., 
McGlynn, K. A., & Bray, F. (2020). Testicular cancer 
incidence predictions in Europe 2010–2035: A rising 
burden despite population ageing. International journal 
of  cancer, 147(3), 820-828. 


