Active surveillance as a successful management strategy for patients with clinical stage I germ cell testicular cancer

2018 ◽  
Vol 21 (6) ◽  
pp. 796-804 ◽  
Author(s):  
R. Escudero-Ávila ◽  
J. D. Rodríguez-Castaño ◽  
I. Osman ◽  
F. Fernandez ◽  
R. Medina ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Germ Cell ◽  
Active Surveillance ◽  
Management Strategy ◽  
Clinical Stage ◽  
Stage I ◽  
Successful Management

scholarly journals Prognostic factors for relapse in patients with clinical stage I testicular cancer: protocol for a Danish nationwide cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e033713 ◽  
Author(s):  
Thomas Wagner ◽  
Birgitte Grønkær Toft ◽  
Birte Engvad ◽  
Jakob Lauritsen ◽  
Michael Kreiberg ◽  
...  
Keyword(s):  
Risk Factors ◽  
Testicular Cancer ◽  
Germ Cell ◽  
Clinical Stage ◽  
Cell Cancer ◽  
Germ Cell Cancer ◽  
Stage I ◽  
Testicular Germ Cell ◽  
Testicular Germ Cell Cancer

IntroductionApproximately one-fourth of patients with clinical stage I testicular germ cell cancer will relapse within 5 years of follow-up. Certain histopathological features in the primary tumour have been associated with an increased risk of relapse. The available evidence on the prognostic value of the risk factors, however, is hampered by heterogeneity of the study populations included and variable reporting of the histopathological features. The aim of this study is to identify pathological risk factors for relapse in an unselected large nationwide cohort of patients with stage I disease.Methods and analysisAll incident cases of stage I testicular germ cell cancer diagnosed in Denmark between 2013 and 2018 will be identified using the nationwide prospective Danish Testicular Cancer (DaTeCa) database. Archived microscopic slides from the orchiectomy specimens will be retrieved through linkage to the Danish Pathology Data Bank and reviewed blinded to the clinical outcome. The DaTeCa database includes 960 stage I seminoma patients with expected 185 relapses and 480 patients with stage I non-seminoma with expected 150 relapses. A minimum follow-up period of 3 years of all patients will be ensured. Predefined prognostic variables will be investigated with regard to relapse in univariable and multivariable analysis using the Cox proportional hazards model.Ethics and disseminationThis study protocol has been approved by the Regional Ethics Committee (Region Zealand, Denmark) and the Danish Data Protection Agency. All data will be managed confidentially according to legislation. Study results will be presented at international conferences and published in peer-review journals.

United States trends in patterns of care in clinical stage I testicular cancer: Results from the National Cancer Database (1998-2011).

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 369-369 ◽  
Author(s):  
Claudio Jeldres ◽  
Craig R. Nichols ◽  
Khanh Pham ◽  
Siamak Daneshmand ◽  
Christian K. Kollmannsberger ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Testicular Cancer ◽  
Active Surveillance ◽  
Treatment Modality ◽  
Clinical Stage ◽  
Stage I ◽  
Patterns Of Care ◽  
Management Options ◽  
Cancer Data ◽  
The Us

369 Background: There has been significant evolution in worldwide guidelines for management of clinical stage I (CS1) testicular cancer where active surveillance (AS) strategies are now considered a first choice, especially for patients with lower recurrence risk after orchiectomy. Conversely, local therapies for CS1 such as primary retroperitoneal lymphadenectomy (RPLND) in non-seminoma and regional radiation in seminoma are phasing out of recommendations. In the US, there have been no comprehensive efforts to measure uptake of guideline recommendations and modern patterns of care for early-stage testicular cancer. Methods: Access to the testicular cancer data set within the National Cancer Data Base (NCDB) was granted to Virginia Mason Medical Center (A SWOG affiliated cancer research program) for this retrospective cohort study. We identified all patients with CS1 testicular cancer between 1998 and 2011. Management options after orchiectomy such as adjuvant radiotherapy, adjuvant chemotherapy, RPLND, or AS were analyzed using cross tabulation and trend analysis. Results: Within the NCDB, of 75,902 patients with testicular cancer, 31,208 and 13,301 were diagnosed with CS1 seminoma and non-seminoma, respectively. For CS1 seminoma, AS use increased from 25.2% in 1998 to 55.8% in 2011. Similarly adjuvant chemotherapy use also increased (1.9 % to 16.7%). Conversely, use of adjuvant radiation decreased from 72.9% to 27.5%. For CS1 non-seminoma, AS remained the main treatment modality ranging between 58.8% and 66.2%. The use of adjuvant chemotherapy increased (28.3% in 2011) and the rate of primary RPLND constantly decreased down to 12.9% that same year. Interestingly, 50.3% of patients with CS1 non-seminoma and negative lympho-vascular invasion status had chemotherapy rather than AS. Trends analyses were statistically significant for all treatment modalities (p<0.05). Conclusions: Active surveillance as a management strategy has increased and is currently the most common treatment modality used for both CS1 seminoma and non-seminoma in the US. Regional therapies in CSI seminoma and non-seminoma are decreasing but persist even in patients with a low risk of recurrence.

scholarly journals Dissecting the Evolving Risk of Relapse over Time in Surveillance for Testicular Cancer

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Madhur Nayan ◽  
Robert J. Hamilton
Keyword(s):  
Testicular Cancer ◽  
Management Strategy ◽  
Clinical Stage ◽  
Stage I ◽  
Risk Estimate ◽  
Conditional Survival ◽  
Common Malignancy ◽  
Over Time ◽  
Risk Of Relapse

Testicular cancer is the most common malignancy in young men, and the incidence is increasing in most countries worldwide. The vast majority of patients present with clinical stage I disease, and surveillance is being increasingly adopted as the preferred management strategy. At the time of diagnosis, patients on surveillance are often counselled about their risk of relapse based on risk factors present at diagnosis, but this risk estimate becomes less informative in patients that have survived a period of time without experiencing relapse. Conditional survival estimates, on the other hand, provide information on a patient’s evolving risk of relapse over time. In this review, we describe the concept of conditional survival and its applications for surveillance of clinical stage I seminoma and nonseminoma germ cell tumours. These estimates can be used to tailor surveillance protocols based on future risk of relapse within risk subgroups of seminoma and nonseminoma, which may reduce the burden of follow-up for some patients, physicians, and the health care system. Furthermore, conditional survival estimates provide patients with a meaningful, evolving risk estimate and may be helpful to reassure patients and reduce potential anxiety of being on surveillance.

Outcomes of surveillance in unselected patients with clinical stage I testicular germ cell tumors: Results of a modern single institution series

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5085-5085 ◽  
Author(s):  
C. J. Moore ◽  
S. Daneshmand ◽  
B. Hayes-Lattin ◽  
W. Stott ◽  
C. R. Nichols
Keyword(s):  
Risk Factors ◽  
Germ Cell ◽  
Active Surveillance ◽  
Clinical Stage ◽  
Cell Cancer ◽  
Complete Data ◽  
Stage I ◽  
Adjuvant Radiation ◽  
Testicular Germ Cell

5085 Background: Orchiectomy is curative in 50–80% of patients (pts) with clinical stage I testicular germ cell cancer (CSITC) and modern chemotherapy at the time of relapse is nearly always curative. Traditional management in the US and Europe, which includes retroperitoneal lymph node dissection (RPLND) or adjuvant radiation or chemotherapy, imposes a significant treatment burden on all patients with CSITC. This study investigated outcomes of active surveillance in all pts with CSITC, with additional post-orchiectomy therapy reserved for only those pts who recur. Methods: Since 1998, Oregon Health & Science University’s institutional policy has been to recommend active surveillance alone to all CSITC pts after orchiectomy, independent of known risk factors. We retrospectively identified and reviewed the charts of 90 pts with CSITC treated between 1998 and 2006. Prognostic factors for relapse, time to relapse, post-orchiectomy treatment required, and overall survival rates were tabulated. Results: Of the 53 pts with CSI nonseminoma, complete data are currently available for 36. 12 (33%) relapsed at a median of 6 months (range 3–48) and all received 3 cycles of bleomycin, etoposide, and cisplatin (BEP). 2 pts (5.5% of total population) required RPLND post-chemotherapy for residual teratoma. No additional relapses have been seen, and all 36 pts are alive at a median follow-up of 51 months. Of 37 pts with CSI seminoma, complete data are available for 28. Seven pts (25%) experienced abdominal relapse, at a median of 10 months (range 3–14 months) after orchiectomy. All 7 pts were treated with abdominal radiation. Two pts subsequently relapsed and were cured with chemotherapy. All CSITC pts are alive without disease at a median follow-up of 60 months. Complete data on all 90 pts will be available this spring. Conclusion: This, the largest modern US series of surveillance alone after orchiectomy, resulted in uniformly excellent outcomes suggesting that primary active surveillance reduces the global burden of treatment for pts with CSITC and is appropriate for all pts with clinical stage I disease, independent of clinical risk factors or pathological subtype. No significant financial relationships to disclose.

Sign in / Sign up

Export Citation Format

Share Document