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Commentary on to “Clinicopathologic predictors of outcomes in children with stage I testicular germ cell tumors: A pooled post hoc analysis of trials from the Children's Oncology Group”

      I commend the authors for studying clinical stage I testis germ cell tumor (TGCT) to identify predictors for relapse during surveillance and I appreciate the challenges that come with analyzing clinical management of a relatively rare disease [
      • Singla N.
      • Wong J.
      • Singla S.
      • Krailo M.
      • Huang L.
      • Shaikh F.
      • et al.
      Clinicopathologic predictors of outcomes in children with Stage I testicular germ cell tumors: a pooled post hoc analysis of trials from the Children's Oncology Group.
      ]. Nonetheless, potential biases should be considered when interpreting the results. The authors analyzed multiple data points (age and pT stage at diagnosis, tumor markers and pathology specimen characteristics) to determine which, if any, affect risk of relapse, development of secondary malignant neoplasm or death during surveillance. Surveillance protocols were not the same for all patients, which the authors acknowledged is a potential selection bias. Of the data points analyzed, only age and AFP level were available for all 106 patients. Tumor pT stage was unknown in 27 percent, beta-HCG unknown in 46 percent and histology unknown in 25 percent of the study population. The authors explained the incidences of unknown, stating that in order to maintain statistical integrity they reported “unknown” unless the full complement of pathologic variables was available. But missing data for a large proportion of a study population could bias results, regardless of the reason for the data missing.
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      References

        • Singla N.
        • Wong J.
        • Singla S.
        • Krailo M.
        • Huang L.
        • Shaikh F.
        • et al.
        Clinicopathologic predictors of outcomes in children with Stage I testicular germ cell tumors: a pooled post hoc analysis of trials from the Children's Oncology Group.
        J Pediatr Urol. 2022; 18: 505-511
        • Rescorla F.J.
        • Ross J.H.
        • Billmire D.F.
        • Dicken B.J.
        • Villaluna D.
        • Davis M.M.
        • et al.
        Surveillance after initial surgery for Stage I pediatric and adolescent boys with malignant testicular germ cell tumors: Report from the Children's Oncology Group.
        J Pediatr Surg. 2015; 50: 1000-1003

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