Surveillance for Stage I Nonseminoma Testicular Cancer: Outcomes and Long-Term Follow-Up in a Population-Based Cohort

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 -