Re: Craniocaudal Retroperitoneal Node Length as a Risk Factor for Relapse from Clinical Stage I Testicular Germ Cell Tumor

363 Background: To investigate if retroperitoneal craniocaudal nodal length (CCNL) or nodal volume (NV) predicts relapse risk in clinical stage I testicular cancer. Methods: This institutional review board-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant study retrospectively reviewed 826 patients with testicular cancer. One hundred eighteen out of 826 patients forming the analytic cohort had stage I disease and either more than or equal to 2 years surveillance or retroperitoneal lymph node dissection with no adjuvant chemotherapy. 3D NVs and CCNL were measured by two attending physicians in consensus. Association between relapse risk and CCNL/NV was evaluated using univariable/multivariable logistic regression analysis adjusted for known prognostic factors. Results: Sixty six out of 118 patients (56%) had nonseminomatous germ cell tumor (NSGCT) and 52 (44%) had seminomatous germ cell tumor (SGCT). Twenty one percent (25 out of 118) of patients relapsed: 24% (16 out of 66) for NSGCT and 17% (9 out of 52) for SGCT. Eighty percent of relapses were limited to the retroperitoneum; 90% of these were at the site of the largest lymph node. CCNL proved to be an independent risk factor in NSGCT using a multivariable logistic regression model adjusting for other potential known risk factors of embryonal predominance (EP) and lymphovascular invasion (LVI). For every 3 mm increase in CCNL, the risk of relapse increased by 52% (odds ratio [OR]=1.52; 95% CI=1.03- 2.25). For patients with SGCT, only the primary tumor size was an independent risk factor for relapse (OR=1.34; 95% CI=1.02-1.75). Conclusions: In NSGCT, CCNL was shown to be associated with increased risk of relapse independently of other known risk factors. If validated in a larger cohort, CCNL could provide important additional information used to inform management decisions in these patients.

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Localized testicular germ cell tumor surveillance: A Delphi consensus study.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e17060 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e17060-e17060

Author(s):

Angélique DA Silva ◽

Aude Flechon ◽

Stephane Culine ◽

François Planchamp ◽

Thibaut Murez ◽

...

Keyword(s):

Germ Cell ◽

Germ Cell Tumor ◽

Delphi Method ◽

Testicular Germ Cell Tumor ◽

Cell Tumor ◽

Stage I ◽

Chest Imaging ◽

Testicular Germ Cell ◽

Surveillance Practice

e17060 Background: Stage I testicular germ cell tumor (TGCT) has excellent cure rates and surveillance is fully included in patient’s management, particularly during the first years of follow-up. Surveillance guidelines differ between the scientific societies, with different recommendations concerning clinical and imaging frequency de-escalation and long term follow-up. We evaluated surveillance practice and schedules followed by French specialists and set up a DELPHI method to obtain a consensual surveillance program with an optimal schedule for patients with localized TGCT. Methods: An online survey on surveillance practice of stage I TGCT based on clinical-cases was conducted among urologists, radiotherapists and oncologists. Results were compared to AFU, ESMO and EAU guidelines. Then a panel of experts assessed surveillance proposals following a formal consensus method (DELPHI method). Statements were drafted after analysis of the previous survey and systematic literature review, with 2 successive rounds to reach a consensus. Results: Survey and DELPHI method were conducted between July 2018 and May 2019. 61 participated to the survey (69% oncologists, 15% urologists, 16% radiotherapists). About 65% of practitioners followed clinico-biological guidelines concerning 1 to 5 years of follow-up, only 25% discontinued surveillance after the 5th year, as recommended. No physician followed the ESMO guidelines of de-escalation chest imaging. A panel of 32 experts (78% oncologists, 16% urologists, 6% radiotherapists) was asked about 38 statements. Consensus was reached for 26 statements concerning clinico-biological surveillance modalities and end of surveillance after the 5th year of follow-up. For seminoma, abdominal ultrasound was proposed as an option to the abdominopelvic (AP) scan for the 4th year of follow-up. No consensus was reached regarding de-escalation of chest imaging. Conclusions: The survey proved that French TGCT specialists do not follow current guidelines. With DELPHI method, a consensus was obtained for frequency of clinico-biological surveillance, discontinuation of surveillance after the 5th year and discontinuation of AP scan on the 4th year of follow-up for seminoma. Questions remains concerning type and frequency of chest imaging.

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