Related Experiment Video
Updated: Mar 14, 2026
Detection of Targetable Alterations in Non-small Cell Lung Cancer using Next-generation Sequencing
Published on: October 10, 2025
Adherence to National Comprehensive Cancer Network® Guidelines for Testicular Cancer
Kevin M Wymer1, Shane M Pearce2, Kelly T Harris3
1Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
Purpose:
Testicular cancer is the most common malignancy among young men and well established treatment guidelines exist to optimize outcomes. We characterized errors in the management of testicular cancer observed among patients seen at 3 referral centers in the United States.
Materials And Methods:
We retrospectively reviewed data from 593 patients presenting with testicular cancer to 3 academic medical centers from 2007 to 2016. Nonguideline directed care was defined as management differing from National Comprehensive Care Network guideline recommendations. Cases of nonguideline directed care were systematically described. Patient and tumor characteristics were compared between guideline directed care and nonguideline directed care. Multivariable logistic regression was used to identify predictors of nonguideline directed care, and Cox regression modeling was used to assess the association between nonguideline directed care and relapse-free survival.
Results:
Nonguideline directed care was identified in 177 of 593 (30%) patients. Inappropriate imaging (44%) and overtreatment (40%) were the most common classifications. Misdiagnosis (24%) and under treatment (16%) occurred relatively frequently, while inappropriate treatment (6%) was rare. Multivariable Cox regression modeling controlling for race, tumor stage and tumor histology identified nonguideline directed care as a significant predictor of relapse (HR 2.49, 95% CI 1.61-3.85, p <0.01).
Conclusions:
Nonguideline directed care of patients with testicular cancer is common, most frequently in the form of inappropriate imaging and overtreatment. Nonguideline directed care leads to delayed definitive therapy, unnecessary morbidity and higher rates of relapse.
Insights
Testicular cancer management errors, including inappropriate imaging and overtreatment, are common. This non-guideline directed care significantly increases relapse risk in young men.
Area of Science:
- Oncology
- Urology
- Clinical Management
Background:
- Testicular cancer is the most common malignancy in young men.
- Established treatment guidelines aim to optimize patient outcomes.
- Variations in care can impact treatment efficacy and patient morbidity.
Purpose of the Study:
- To characterize errors in testicular cancer management.
- To identify the frequency and types of non-guideline directed care.
- To assess the impact of non-guideline directed care on relapse-free survival.
Main Methods:
- Retrospective review of 593 testicular cancer patients from 3 US academic centers (2007-2016).
- Defined non-guideline directed care based on National Comprehensive Care Network guidelines.
- Used multivariable logistic and Cox regression to analyze predictors and outcomes.
Main Results:
- Non-guideline directed care was observed in 30% of patients (177/593).
- Most common errors included inappropriate imaging (44%) and overtreatment (40%).
- Non-guideline directed care significantly predicted relapse (HR 2.49, p <0.01).
Conclusions:
- Non-guideline directed care in testicular cancer is prevalent.
- Inappropriate imaging and overtreatment are frequent management deviations.
- Deviations from guidelines lead to delayed therapy, increased morbidity, and higher relapse rates.
More Related Videos
Related Concept Videos
01:20Disorders of the Male Reproductive System
Prostate disorders are another major concern. These conditions can impair urinary flow due to the prostate's location around the urethra....
02:56Treatment Resistant Cancers