DECISION ANALYSIS MODEL FOR CLINICAL STAGE I NON- SEMINOMATOUS GERM CELL TESTICULAR CANCER

Abstract Background Different from adult clinical stage I (CS1) testicular cancer, surveillance was recommended for CS1 pediatric testicular cancer. For high-risk children, greater than 50% of them suffered relapse and progress during surveillance and adjuvant chemotherapy was administrated. Risk-adapted treatment might reduce chemotherapy burden for those children.Methods Using decision analysis model, we collected clinical utilities from literature and survey and compared chemotherapy exposure between risk-adapted treatment and surveillance.Results In base case decision analysis of CS1 pediatric testicular cancer, risk-adapted treatment preferred lower exposure of chemotherapy than surveillance (average: 0.7965 cycle verse 1.3419 cycles). The sensitivity analysis demonstrated that when relapse rate after primary chemotherapy ≤ 0.10 and the relapse rate of high-risk group ≥ 0.40, risk-adapted treatment would expose lower chemotherapy, without association of the proportion of low-risk patients, the relapse rate of low-risk group, relapse rate after salvage chemotherapy and toxicity utility of second-line chemotherapy compared to salvage chemotherapy.Conclusions Risk-adapted treatment might decrease chemotherapy-related toxicity for these high-risk patients and further clinical study was needed.

Download Full-text

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

BMJ Open ◽

10.1136/bmjopen-2019-033713 ◽

2019 ◽

Vol 9 (10) ◽

pp. e033713 ◽

Cited By ~ 2

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.

Download Full-text

LAPAROSCOPIC RETROPERITONEAL LYMPH NODE DISSECTION FOR CLINICAL STAGE I NONSEMINOMATOUS GERM CELL TESTICULAR CANCER: CURRENT STATUS ■

Textbook of Laparoscopic Urology ◽

10.3109/9781420021202-61 ◽

2006 ◽

pp. 645-650

Keyword(s):

Lymph Node ◽

Testicular Cancer ◽

Germ Cell ◽

Lymph Node Dissection ◽

Clinical Stage ◽

Stage I ◽

Current Status ◽

Retroperitoneal Lymph Node Dissection ◽

Node Dissection ◽

Retroperitoneal Lymph Node

Download Full-text

Incidence of Disease Outside Modified Retroperitoneal Lymph Node Dissection Templates in Clinical Stage I or IIA Nonseminomatous Germ Cell Testicular Cancer

The Journal of Urology ◽

10.1016/j.juro.2006.10.045 ◽

2007 ◽

Vol 177 (3) ◽

pp. 937-943 ◽

Cited By ~ 63

Author(s):

Scott E. Eggener ◽

Brett S. Carver ◽

David S. Sharp ◽

Robert J. Motzer ◽

George J. Bosl ◽

...

Keyword(s):

Lymph Node ◽

Testicular Cancer ◽

Germ Cell ◽

Lymph Node Dissection ◽

Clinical Stage ◽

Stage I ◽

Retroperitoneal Lymph Node Dissection ◽

Node Dissection ◽

Retroperitoneal Lymph Node

Download Full-text

Laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell testicular cancer: a long-term update

Urology ◽

10.1016/s0090-4295(03)00324-8 ◽

2003 ◽

Vol 62 (2) ◽

pp. 324-327 ◽

Cited By ~ 86

Author(s):

Sam B Bhayani ◽

Albert Ong ◽

William K Oh ◽

Philip W Kantoff ◽

Louis R Kavoussi

Keyword(s):

Lymph Node ◽

Testicular Cancer ◽

Germ Cell ◽

Lymph Node Dissection ◽

Clinical Stage ◽

Stage I ◽

Retroperitoneal Lymph Node Dissection ◽

Node Dissection ◽

Retroperitoneal Lymph Node

Download Full-text

Management of Clinical Stage I Nonseminomatous Germ Cell Testicular Cancer

Urologic Clinics of North America ◽

10.1016/j.ucl.2007.02.001 ◽

2007 ◽

Vol 34 (2) ◽

pp. 137-148 ◽

Cited By ~ 25

Author(s):

Toni K. Choueiri ◽

Andrew J. Stephenson ◽

Timothy Gilligan ◽

Eric A. Klein

Keyword(s):

Testicular Cancer ◽

Germ Cell ◽

Clinical Stage ◽

Stage I

Download Full-text

Prognostic factors in clinical stage I nonseminomatous germ cell tumors of the testis: multivariate analysis of a prospective multicenter study. Swedish-Norwegian Testicular Cancer Group.

Journal of Clinical Oncology ◽

10.1200/jco.1990.8.3.509 ◽

1990 ◽

Vol 8 (3) ◽

pp. 509-518 ◽

Cited By ~ 123

Author(s):

O Klepp ◽

A M Olsson ◽

H Henrikson ◽

N Aass ◽

O Dahl ◽

...

Keyword(s):

Prognostic Factors ◽

Testicular Cancer ◽

Germ Cell ◽

Primary Tumor ◽

Vascular Invasion ◽

Clinical Stage ◽

Germ Cell Tumors ◽

Stage I ◽

Retroperitoneal Lymphadenectomy ◽

Nonseminomatous Germ Cell Tumors

Between 1981 and 1986, 279 consecutive patients with clinical stage I (CS1) nonseminomatous germ cell tumors (NSGCT) of the testis underwent pathological staging (PS) with retroperitoneal lymphadenectomy (RPLND). Patients with retroperitoneal metastases (PS2) received adjuvant chemotherapy. The median follow-up time after RPLND was 50 months (range, 30 to 90). Clinical and histopathologic features were registered prospectively and analyzed for association with risk of having PS2, relapse despite pathological stage 1 (PS1) or the combined risk of either event, metastatic disease (MET). Seventy-five (26.9%) of the patients had PS2 disease, and 30 (14.7%) of the 204 PS1 patients relapsed, indicating that at least 105 (37.6%) of this CS1 population had subclinical MET at the time of orchiectomy. Four (1.4%) of the 279 CS1 patients died of testicular cancer. Multivariate analyses showed several variables to be significantly associated with outcome for the CS1 patients; vascular invasion in primary tumor and normal preorchiectomy serum alpha-fetoprotein (Pre-AFP) level indicated PS2 disease. If Pre-AFP was excluded from the model, the absence of teratoma or yolk sac elements in the primary tumor became significant predictors of PS2. Vascular invasion, absence of teratoma, and a short interval between orchiectomy and RPLND indicated increased risk of relapse in PS1 patients. Vascular invasion, normal Pre-AFP, absence of teratoma elements, and a short orchiectomy to RPLND interval were predictive of MET. Our results indicate that prognostic factors useful for stratification of CS1 patients with NSGCT to different treatment options may be established.

Download Full-text