TY - JOUR
T1 - Surveillance for Stage I Nonseminoma Testicular Cancer
T2 - Outcomes and Long-Term Follow-Up in a Population-Based Cohort
AU - Daugaard, Gedske
AU - Gundgaard, Maria Gry
AU - Mortensen, Mette Saksø
AU - Agerbæk, Mads
AU - Holm, Niels Vilstrup
AU - Rørth, Mikael
AU - von der Maase, Hans
AU - Christensen, Ib Jarle
AU - Lauritsen, Jakob
N1 - © 2014 by American Society of Clinical Oncology.
PY - 2014/12/1
Y1 - 2014/12/1
N2 - PURPOSE: To describe treatment results in a large cohort with stage I nonseminoma germ cell cancer (NSGCC) treated in a surveillance program.PATIENTS AND METHODS: From January 1, 1984, to December 31, 2007, 1,226 patients with stage I NSGCC, including high-risk patients with vascular invasion, were observed in a surveillance program.RESULTS: The relapse rate after orchiectomy alone was 30.6% at 5 years. Presence of vascular invasion together with embryonal carcinoma and rete testis invasion in the testicular primary identified a group with a relapse risk of 50%. Without risk factors, the relapse risk was 12%. Eighty percent of relapses were diagnosed within the first year after orchiectomy. The median time to relapse was 5 months (range, 1 to 308 months). Early relapses were mainly detected by increase in tumor markers, and late relapses were detected by computed tomography scans. Relapses after 5 years were seen in 0.5% of the whole cohort or in 1.6% of relapsing patients. The majority of relapses (94.4%) belonged to the good prognostic group according to the International Germ Cell Cancer Collaborative Group classification. The disease-specific survival at 15 years was 99.1%.CONCLUSION: A surveillance policy for patients with stage I NSGCC is a safe approach associated with an excellent cure rate and an overall low treatment burden despite a high relapse rate in a small group of patients. We recommend surveillance for patients with stage I NSGCC with immediate systemic treatment at relapse. Clearly defined risk factors for relapse are presented if an option of risk-adapted treatment is preferred.
AB - PURPOSE: To describe treatment results in a large cohort with stage I nonseminoma germ cell cancer (NSGCC) treated in a surveillance program.PATIENTS AND METHODS: From January 1, 1984, to December 31, 2007, 1,226 patients with stage I NSGCC, including high-risk patients with vascular invasion, were observed in a surveillance program.RESULTS: The relapse rate after orchiectomy alone was 30.6% at 5 years. Presence of vascular invasion together with embryonal carcinoma and rete testis invasion in the testicular primary identified a group with a relapse risk of 50%. Without risk factors, the relapse risk was 12%. Eighty percent of relapses were diagnosed within the first year after orchiectomy. The median time to relapse was 5 months (range, 1 to 308 months). Early relapses were mainly detected by increase in tumor markers, and late relapses were detected by computed tomography scans. Relapses after 5 years were seen in 0.5% of the whole cohort or in 1.6% of relapsing patients. The majority of relapses (94.4%) belonged to the good prognostic group according to the International Germ Cell Cancer Collaborative Group classification. The disease-specific survival at 15 years was 99.1%.CONCLUSION: A surveillance policy for patients with stage I NSGCC is a safe approach associated with an excellent cure rate and an overall low treatment burden despite a high relapse rate in a small group of patients. We recommend surveillance for patients with stage I NSGCC with immediate systemic treatment at relapse. Clearly defined risk factors for relapse are presented if an option of risk-adapted treatment is preferred.
KW - Adolescent
KW - Adult
KW - Aged
KW - Denmark
KW - Disease-Free Survival
KW - Humans
KW - Kaplan-Meier Estimate
KW - Male
KW - Middle Aged
KW - Neoplasm Invasiveness
KW - Neoplasm Recurrence, Local
KW - Neoplasm Staging
KW - Neoplasms, Germ Cell and Embryonal
KW - Orchiectomy
KW - Population Surveillance
KW - Predictive Value of Tests
KW - Retrospective Studies
KW - Risk Factors
KW - Testicular Neoplasms
KW - Time Factors
KW - Tomography, X-Ray Computed
KW - Treatment Outcome
KW - Tumor Markers, Biological
KW - Young Adult
U2 - 10.1200/jco.2013.53.5831
DO - 10.1200/jco.2013.53.5831
M3 - Journal article
C2 - 25267754
SN - 0732-183X
VL - 32
SP - 3817
EP - 3823
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 34
ER -
