Testicular tumour size and rete testis invasion as prognostic factors for the risk of relapse of clinical stage I seminoma testis patients under surveillance: A systematic review by the Testicular Cancer Guidelines Panel

2018 ◽  
Vol 17 (2) ◽  
pp. e1740-e1741 ◽  
Author(s):  
J.L. Boormans ◽  
J. Mayor de Castro ◽  
L. Marconi ◽  
Y. Yuan ◽  
M.P. Laguna Pes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Prognostic Factors ◽  
Testicular Cancer ◽  
Tumour Size ◽  
Clinical Stage ◽  
Rete Testis ◽  
Stage I ◽  
Stage I Seminoma ◽  
Cancer Guidelines ◽  
Risk Of Relapse

Prognostic factors for tumor recurrence in patients with clinical stage I seminoma undergoing surveillance—A systematic review

2018 ◽  
Vol 36 (10) ◽  
pp. 448-458 ◽  
Author(s):  
Friedemann Zengerling ◽  
Frank Kunath ◽  
Katrin Jensen ◽  
Christian Ruf ◽  
Stefanie Schmidt ◽  
...  
Keyword(s):  
Systematic Review ◽  
Prognostic Factors ◽  
Tumor Recurrence ◽  
Clinical Stage ◽  
Stage I ◽  
Stage I Seminoma

Prognostic factors for relapse in stage I seminoma managed by surveillance or adjuvant carboplatin: A multivariate analysis on 588 cases

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4552-4552 ◽  
Author(s):  
J. Aparicio ◽  
J. Garcia-Puche ◽  
M. Lomas ◽  
F. Carabantes ◽  
S. Vazquez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Tumor Size ◽  
Cox Regression ◽  
Clinical Stage ◽  
Disease Free Survival ◽  
Rete Testis ◽  
Stage I ◽  
Histologic Subtype ◽  
Stage I Seminoma

4552 Background: The availability of reliable prognostic factors for relapse in stage I seminoma would allow a better patient stratification for individually tailored therapies. We performed a pooled analysis of patients included in two consecutive risk-adapted protocols. Methods: Between 1994 and 2004, 588 cases were prospectively registered. Median patient age was 33 years, median tumor size was 45 mm, serum BHCG levels were elevated preoperatively in 14.6%, and rete testis invasion was present in 26.9%. Three hundred and four patients (51.7%) with risk factors received two courses of adjuvant carboplatin, whereas 284 (48.3%) without these criteria were managed by surveillance. After a median follow-up of 48 months (range, 12–144), 43 relapses (7.3%) have occurred. Five-year disease-free survival was 92.3%. Univariate (log rank) and multivariate (Cox regression) analyses of prognostic factors for relapse were performed. Results: Relapses were less frequent after carboplatin treatment (3% vs 12%, p < 0.0001). Statistically significant, independent predictors of relapse were: 1) rete testis invasion and age (<30 years) in the whole series; 2) rete testis invasion for patients treated with adjuvant chemotherapy; and 3) tumor invasion beyond the albuginea and microvessel neoplastic invasion (defining 1997 AJCC pT2–4 staging) for patients managed by surveillance. In contrast, tumor size, histologic subtype (anaplastic), and serum preoperative BHCG levels were not associated with prognosis. Conclusions: Invasion of the rete testis and age (<30 years) represent high-risk factors for patients with clinical stage I testis seminoma, independently of the treatment selected. These two features, in combination with pathologic T2–4 staging, could improve patient selection for risk-adapted therapies. No significant financial relationships to disclose.

Surveillance for stage I testicular seminoma: Retrospective analysis of prognostic factors for relapse at a single institution in Japan

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15630-15630
Author(s):  
K. Kakimoto ◽  
Y. Ono ◽  
N. Meguro ◽  
A. Kawashima ◽  
T. Kinouchi ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Survival Rate ◽  
Vascular Invasion ◽  
Lymphatic Invasion ◽  
Rete Testis ◽  
Stage I ◽  
Single Institution ◽  
Testicular Seminoma ◽  
Beta Hcg ◽  
Stage I Seminoma

15630 Background: Treatment options for clinical stage I seminoma include adjuvant radiotherapy (RT) as well as surveillance and adjuvant chemotherapy. Although adjuvant RT remains the treatment of choice in most centers, the success of surveillance of patients with stage I nonseminomatous germ cell tumors and the establishment of curative chemotherapy for advanced disease have led to re-examination of the standard treatment approach. Data available from the surveillance and adjuvant RT series suggest that nearly 100% of patients with stage I testicular seminoma are cured, whichever approach is chosen. We report here results of a retrospective analysis of prognostic factors for stage I testicular seminoma. Methods: Between January 1980 and December 2004, surveillance was performed for 61 patients. Tumor characteristics (age at diagnosis, size, elevation of beta hCG level, invasion of the rete testis, vascular invasion, and lymphatic invasion) were examined as factors possibly predictive of relapse. Cause-specific survival rate was calculated using the Kaplan-Meier method. Results: With a median follow-up of 10.5 years (range, 2.35–20.8 years), 7 relapses were observed, with an actuarial 5- year relapse-free rate (RFR) of 89.2%. On univariate analysis, only tumor size (RFR: <8cm, 96%; =8cm, 76%; p=0.029) was predictive of relapse. Age at diagnosis (RFR: <36, 89%; =36, 91%), elevation of beta hCG level (RFR: 93% [normal] v 91% [elevated]), invasion of the rete testis (RFR:92% [absent] v 90% [present]), vascular invasion (RFR:89% [absent] v 86% [present]), and lymphatic invasion (RFR: 89% [absent] v 78% [present]) were not predictive of relapse. The overall relapse rate was 11.5%. Overall 5-year survival rate was 97%. Conclusions: Size of primary tumor was found to be predictive of relapse in patients with stage I seminoma managed with surveillance, on analysis at a single institution in Japan. No significant financial relationships to disclose.

Prognostic Factors for Relapse in Stage I Seminoma Managed by Surveillance: A Pooled Analysis

2002 ◽  
Vol 20 (22) ◽  
pp. 4448-4452 ◽  
Author(s):  
Padraig Warde ◽  
Lena Specht ◽  
Alan Horwich ◽  
Tim Oliver ◽  
Tony Panzarella ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Tumor Size ◽  
Pooled Analysis ◽  
Rete Testis ◽  
Hazard Ratio ◽  
Stage I ◽  
Management Options ◽  
Histologic Subtype ◽  
Stage I Seminoma

PURPOSE: Several management options are available to patients with stage I seminoma, including adjuvant radiotherapy, surveillance, and adjuvant chemotherapy. We performed a pooled analysis of patients from the four largest surveillance studies to better delineate prognostic factors associated with disease progression. PATIENTS AND METHODS: Individual patient data were obtained from each center (Princess Margaret Hospital, Danish Testicular Cancer Study Group, Royal Marsden Hospital, and Royal London Hospital) for 638 patients. Tumor characteristics (size, histologic subtype, invasion of rete testis, and tumor invasion into small vessels [SVI]) as well as age at diagnosis were analyzed for prognostic importance for relapse. RESULTS: With a median follow-up of 7.0 years (range, 0.02 to 17.5 years), 121 relapses were observed for an actuarial 5-year relapse-free rate (RFR) of 82.3%. On univariate analysis, tumor size (RFR: ≤ 4 cm, 87%; > 4 cm, 76%; P = .003), rete testis invasion (RFR: 86% [absent] v 77% [present], P = .003), and the presence of SVI (RFR: 86% [absent] v 77% [present], P = .038) were predictive of relapse. On multivariate analysis, tumor size (≤ 4 cm v > 4 cm, hazard ratio 2.0; 95% confidence interval [CI], 1.3 to 3.2) and invasion of the rete testis (hazard ratio 1.7; 95% CI, 1.1 to 2.6) remained as important predictors for relapse. CONCLUSION: We have identified size of primary tumor and rete testis invasion as important prognostic factors for relapse in patients with stage I seminoma managed with surveillance. This information will allow patients and clinicians to choose management based on a more accurate assessment of an individual patient’s risk of relapse. In addition, it will allow clinicians to tailor follow-up protocols based on risk of occult disease.

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.

The ABC-study: A randomized phase III study comparing one course of adjuvant bleomycin, etoposide, and cisplatin (BEP) and one course of carboplatin AUC7 in clinical stage I seminomatous testicular cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. TPS4593-TPS4593
Author(s):  
Torgrim Tandstad ◽  
Olof Stahl ◽  
Olav Dahl ◽  
Ingrid Glimelius ◽  
Hege Sagstuen Haugnes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Testicular Cancer ◽  
Relapse Rate ◽  
Adjuvant Treatment ◽  
Clinical Stage ◽  
Dropout Rate ◽  
Rete Testis ◽  
Stage I ◽  
Phase Iii ◽  
Phase Iii Study

TPS4593 Background: Clinical stage I seminomatous testicular cancer is by far the most frequent presentation of testicular cancer. Treatment options include surveillance or adjuvant treatment, internationally one course of adjuvant carboplatin (AUC7) is the preferred adjuvant treatment. Tumor size and stromal invasion in the rete testis can be used to identify patients with a higher risk of relapse. Recent data have showed only a modest effect of adjuvant carboplatin in preventing relapse, and more potent adjuvant therapies should be explored to this group of patients. Methods: The ABC-study is a investigator initiated randomized, open, phase III study comparing standard adjuvant chemotherapy in the form of one course carboplatin AUC7 to one course of BEP (Bleomycin, etoposide and cisplatin), in patients with one or two risk factors. Based on SWENOTECA data from one course of adjuvant carboplatin AUC7 we estimate the relapse rate in patients with one or two risk factors to be 9 %. We consider a reduction in relapse free survival of 7 % to be the minimum difference that will lead to routine use of one course of adjuvant BEP. To demonstrate an improvement in relapse rate from 9 to 2 % with an α = 0.05 and β = 0.80, 332 evaluable patients are required. We expect a dropout rate of maximum 5 %, and therefore intend to randomize a total of 348 patients. Enrollment in the study started in 2015, and as of February 1. 2017 a total of 66 patients have been enrolled. Accrual have been slower than expected, but the current accrual rate is about 6-7 patients a month. We invite institutions and collaboratory groups to participate in this study. NCT02341989. EUDRACT 2014-004075-23. Clinical trial information: NCT02341989.

Prognostic factors in stage I non-seminomatous germ-cell testicular tumors managed by orchiectomy and surveillance: implications for adjuvant chemotherapy.

1986 ◽  
Vol 4 (7) ◽  
pp. 1031-1036 ◽  
Author(s):  
P Hoskin ◽  
S Dilly ◽  
D Easton ◽  
A Horwich ◽  
W Hendry ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Adjuvant Chemotherapy ◽  
Germ Cell ◽  
Clinical Stage ◽  
Prognostic Significance ◽  
Lymphatic Invasion ◽  
Rete Testis ◽  
Stage I ◽  
Testicular Tumors ◽  
Increased Risk

Between February 1979 and March 1985, 126 patients with clinical stage I non-seminomatous germ-cell testicular tumors were entered into a surveillance study after orchiectomy. Of this group, 36 (28%) have relapsed. The prognostic significance of 13 clinical, histopathologic, and biochemical factors has been analyzed. Vascular invasion and lymphatic invasion (LI) within the primary tumor, histology, and involvement of the epididymis and rete testis were significantly associated with an increased risk of relapse. However, multiple regression analysis showed that only histology and LI were significant, independent prognostic factors. These findings provide the basis for the consideration of adjuvant chemotherapy for patients with apparent clinical stage I testicular non-seminoma who are at high risk of harboring occult metastases.

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