Chemotherapy burden of risk-adapted treatment verse surveillance for clinical stage I pediatric testicular cancer: A decision tree model analysis
Abstract Background Different from adult clinical stage I (CS1) testicular cancer, surveillance was recommended for CS1 pediatric testicular cancer. This study was to compare chemotherapy exposure between risk-adapted treatment and surveillance in CS1 pediatric testicular cancer.Methods We collected clinical utilities from literature and survey. Using decision analysis model, we compared chemotherapy exposure between risk-adapted treatment and surveillance and sensitivity analysis was performed.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.Conclusion Decision analysis demonstrated that risk-adapted treatment was associated with lower exposure of chemotherapy for patients with CS1 pediatric testicular cancer. This might decrease chemotherapy-related toxicity for these high-risk patients and further clinical study was needed.