scholarly journals Prognostic factors for tumor recurrence in patients with clinical stage I seminoma undergoing surveillance—protocol for a systematic review

2015 ◽  
Vol 4 (1) ◽  
Author(s):  
Frank Kunath ◽  
Annabel Spek ◽  
Katrin Jensen ◽  
Friedemann Zengerling ◽  
Stefanie Schmidt
Keyword(s):  
Systematic Review ◽  
Prognostic Factors ◽  
Tumor Recurrence ◽  
Clinical Stage ◽  
Stage I ◽  
Stage I Seminoma ◽  
Surveillance Protocol

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

Stage I nonseminomatous germ cell tumors of the testis: Clinical outcome of 45 patients on a surveillance protocol after orchiectomy alone at a single institution in Japan

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16165-e16165
Author(s):  
K. Kakimoto ◽  
Y. Ono ◽  
N. Meguro ◽  
K. Takezawa ◽  
T. Yoshida ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Lymph Nodes ◽  
Germ Cell ◽  
Embryonal Carcinoma ◽  
Clinical Stage ◽  
Germ Cell Tumors ◽  
Stage I ◽  
Single Institution ◽  
Surveillance Protocol

e16165 Background: In Japan, risk-adapted treatment for patients with clinical stage I nonseminomatous germ cell tumor of the testis (NSGCTT) has been performed in very few institutions. This retrospective study was performed to evaluate histopathologic prognostic factors with stage I NSGCTT for whom careful follow-up with a surveillance protocol was possible at a single institution. Methods: We included 45 patients with a median age of 31 years (range 16 - 58) who were managed with a surveillance strategy after orchiectomy in our department between 1972 and 2006. Mean duration of follow-up was 8.1 years (range 1.4 –30). The patients were monitored at follow-up evaluation for tumor marker (AFP, beta-hCG) levels and by abdominal CT scan, chest x-ray, and physical examination. Primary testis tumor samples were assessed for prognostic factors including lymphatic and/or vascular (LV) invasion and pathological components such as the presence of embryonal carcinoma. Log-rank analyses were performed to identify prognostic factors. Results: All patients were alive and disease-free. Relapses occurred in 16 (35.6%) patients after a median follow-up of 5.7 months (range 3–45). In 11 patients (68.8 %), relapse was detected in the retroperitoneal lymph nodes. Two patients (12.5%) had metastases in the retroperitoneal lymph nodes and lungs, two patients (12.5%) had metastases in the lungs alone, and one patient (6.2%) had metastases in the retroperitoneal lymph nodes, lungs, and brain. LV invasion was identified in 17 patients, 53% of whom had relapsed, and relapse was found in 25% of 28 patients without LV invasion (p<0.01). Of 31 patients with an embryonal carcinoma component, 13 patients (42%) developed metastases, whereas 21% of those without an embryonal carcinoma component developed metastases (p=0.04). After chemotherapy and/or surgical treatment for relapse, the 5-year overall survival rate was 100%. Conclusions: As in previous reports, the presence of an embryonal carcinoma component and LV invasion appeared to be factors suggesting a high likelihood of relapse. The surveillance protocol described here is a reliable strategy for stage I NSGCTT patients if careful long-term follow-up is possible. No significant financial relationships to disclose.

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.

Phase II Study: Adjuvant Single-Agent Carboplatin Therapy for Clinical Stage I Seminoma

1997 ◽  
Vol 31 (4) ◽  
pp. 405-407 ◽  
Author(s):  
S. Krege ◽  
G. Kalund ◽  
T. Otto ◽  
M. Goepel ◽  
H. Rübben
Keyword(s):  
Phase Ii ◽  
Phase Ii Study ◽  
Clinical Stage ◽  
Single Agent ◽  
Stage I ◽  
Stage I Seminoma

Stage I nonseminomatous germ cell testicular tumor: prediction of metastatic potential by primary histopathology.

1988 ◽  
Vol 6 (9) ◽  
pp. 1467-1473 ◽  
Author(s):  
C Y Fung ◽  
L A Kalish ◽  
G L Brodsky ◽  
J P Richie ◽  
M B Garnick
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Germ Cell ◽  
Vascular Invasion ◽  
Clinical Stage ◽  
Testicular Tumor ◽  
Tumor Stage ◽  
Nodal Metastasis ◽  
Stage I ◽  
Rational Approach

A study of 60 patients with clinical stage I nonseminomatous germ cell testicular tumor (NSGCT) was conducted to identify prognostic factors that may predict the likelihood of metastasis. Clinical features and histopathologic features of the primary testicular tumor were examined and analyzed for correlations with the presence of retroperitoneal nodal metastasis documented by surgery (N+) and with development of relapse (R+). Pathologic tumor stage greater than or equal to 2, with tumor extension into the tunica albuginea, rete testis, epididymis, or spermatic cord, was correlated with an increased rate of N+ compared with pathologic tumor stage I (P = .001). Vascular invasion was correlated with a higher rate of N+ (P = .05) and had a similar association with R+ (P = .08). Tumors containing less than 50% teratoma were found to have a higher rate of N+ than tumors with greater than or equal to 50% teratoma (P = .02). Based on the identified prognostic factors, a model for predicting the probability of retroperitoneal nodal metastasis in clinical stage I patients is proposed. The risk factors for nodal metastasis are: pathologic tumor stage greater than or equal to 2, vascular invasion, and less than 50% teratoma. Patients with none of the risk factors are considered at low risk and may be offered orchiectomy alone with surveillance for initial treatment. Patients with all three risk factors are at high risk and should be treated with a retroperitoneal lymph node dissection (RPLND) or possibly chemotherapy. Patients with one or two risk factors are at intermediate risk; it is recommended that they undergo RPLND. This risk model facilitates a rational approach to the management of clinical stage I NSGCT.

Combined-Modality Therapy for Clinical Stage I or II Hodgkin's Lymphoma: Long-Term Results of the European Organisation for Research and Treatment of Cancer H7 Randomized Controlled Trials

2006 ◽  
Vol 24 (19) ◽  
pp. 3128-3135 ◽  
Author(s):  
Evert M. Noordijk ◽  
Patrice Carde ◽  
Noëlle Dupouy ◽  
Anton Hagenbeek ◽  
Augustinus D.G. Krol ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Disease Control ◽  
Hodgkin’S Lymphoma ◽  
Early Stage ◽  
Combined Modality Therapy ◽  
Clinical Stage ◽  
Stage I ◽  
Hodgkin's Lymphoma ◽  
Long Term Results ◽  
Experimental Therapy

Purpose In early-stage Hodgkin's lymphoma (HL), subtotal nodal irradiation (STNI) and combined chemotherapy/radiotherapy produce high disease control rates but also considerable late toxicity. The aim of this study was to reduce this toxicity using a combination of low-intensity chemotherapy and involved-field radiotherapy (IF-RT) without jeopardizing disease control. Patients and Methods Patients with stage I or II HL were stratified into two groups, favorable and unfavorable, based on the following four prognostic factors: age, symptoms, number of involved areas, and mediastinal-thoracic ratio. The experimental therapy consisted of six cycles of epirubicin, bleomycin, vinblastine, and prednisone (EBVP) followed by IF-RT. It was randomly compared, in favorable patients, to STNI and, in unfavorable patients, to six cycles of mechlorethamine, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine (MOPP/ABV hybrid) and IF-RT. Results Median follow-up time of the 722 patients included was 9 years. In 333 favorable patients, the 10-year event-free survival rates (EFS) were 88% in the EBVP arm and 78% in the STNI arm (P = .0113), with similar 10-year overall survival (OS) rates (92% v 92%, respectively; P = .79). In 389 unfavorable patients, the 10-year EFS rate was 88% in the MOPP/ABV arm compared with 68% in the EBVP arm (P < .001), leading to 10-year OS rates of 87% and 79%, respectively (P = .0175). Conclusion A treatment strategy for early-stage HL based on prognostic factors leads to high OS rates in both favorable and unfavorable patients. In favorable patients, the combination of EBVP and IF-RT can replace STNI as standard treatment. In unfavorable patients, EBVP is significantly less efficient than MOPP/ABV.

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