Background and objective

Testicular germ cell tumors (TGCTs) are globally rare, although incidence significantly varies across global geographic regions and ethnicities. Recent decades have seen an unexplained increase in incidence. This review investigates the changing epidemiology of TGCT and identifies key risk factors.

Methods

A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 statement was conducted. After screening and risk-of-bias assessment, 53 reports on significant and updated topics on TGCT epidemiology and risk factors were included for narrative synthesis. Of these, 26 were selected for quantitative synthesis.

Key findings and limitations

Projections suggest a continued increase in global TGCT incidence, even in populations with historically low incidence. Genetic predisposition, particularly single-nucleotide polymorphisms, accounts for approximately 44% of TGCT heritability. In utero exposure to endocrine-disrupting chemicals, cryptorchidism, infertility, high height, behavioral factors such as marijuana consumption, and environmental or occupational exposures to potentially harmful substances are associated with higher TGCT risk, with variable strength of evidence. Meta-analyses confirmed a significant association between prenatal/early-life risk factors and TGCT incidence (odds ratio 1.44). Limitations include constrained evidence quality, heterogeneity in study types, and a limited volume of data supporting each topic.

Conclusions and clinical implications

TGCT pathogenesis is influenced by genetic predisposition and exposures during early life. The rising incidence may reflect socioeconomic changes and migration patterns, which determine variation in population exposure to risk factors. TGCT epidemiology remains controversial and requires further research and the implementation of optimal screening programs considering the rising incidence and consequent impact on global health and socioeconomic systems.

Advancing practice

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Patient summary

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中文翻译：

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睾丸癌的流行病学和危险因素：系统评价

 背景和目标

睾丸生殖细胞瘤 （TGCT） 在全球范围内罕见，尽管全球地理区域和种族的发病率差异很大。近几十年来，发病率出现了无法解释的增加。本综述调查了 TGCT 流行病学的变化并确定了关键的危险因素。

 方法

根据 2020 年系统评价和荟萃分析的首选报告项目声明进行了系统评价。经过筛选和偏倚风险评估，纳入了 53 份关于 TGCT 流行病学和危险因素的重要和更新主题的报告进行叙述综合。其中，选择 26 种进行定量合成。

主要发现和局限性

预测表明，全球 TGCT 发病率持续增加，即使在历史上发病率较低的人群中也是如此。遗传易感性，尤其是单核苷酸多态性，约占 TGCT 遗传性的 44%。在子宫内暴露于内分泌干扰化学物质、隐睾症、不孕症、高身高、行为因素（如大麻消费）以及环境或职业暴露于潜在有害物质与较高的 TGCT 风险相关，证据强度各不相同。荟萃分析证实，产前/早期危险因素与 TGCT 发病率之间存在显著相关性 （比值比 1.44）。局限性包括证据质量受限、研究类型的异质性以及支持每个主题的数据量有限。

结论和临床意义

TGCT 的发病机制受遗传易感性和早期暴露的影响。发病率上升可能反映了社会经济变化和迁移模式，这决定了人群暴露于风险因素的差异。TGCT 流行病学仍然存在争议，考虑到发病率的上升及其对全球卫生和社会经济系统的影响，需要进一步研究和实施最佳筛查计划。

 推进实践

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 患者总结

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