A nationwide cohort study of surveillance for stage I seminoma.

Abstract

4502 Background: The standard treatment for stage I seminoma remains a topic for discussion. Survival rates are excellent irrespective of treatment modality (radiotherapy, carboplatin or surveillance). However, late effects might differ between treatment options. Only smaller surveillance studies with limited follow-up have previously been published. We present data from a large nationwide cohort study on surveillance in stage I seminoma patients. Methods: A nationwide and population based clinical database covering germ cell cancer patients diagnosed 1984-2007 was constructed. The database included 4,683 cases. All stage I seminoma patients followed by surveillance were identified. Possible prognostic factors for relapse were collected from patient files and pathology reports. By merging our data with the national patient registry we were able to collect data on late relapses, vital status and cause of death on all patients up to December 2012. Results: 1,822 patients with stage I seminoma were followed on a surveillance program. The median follow-up time was 15.4 years. Ten year cancer specific survival (CSS) was 99.6%. A total of 355 (19.5%) patients had a relapse after a median time of 13.7 months (range 1.2-173.7 months). Within 2-5 years after orchiectomy, 72 patients (4.0 %) had a relapse and 26 patients (1.4 %) had a relapse more than 5 years after orchiectomy. Invasion of blood or lymphatic vessels, tumor size > 4 cm and serum human chorionic gonadotropin > 200 IU/L were all predictive factors for relapse in both univariate and multivariate analyses (p<0.01). Invasion of rete testis was significant in the univariate analysis but not in the multivariate analyses (p=0.53). Conclusions: We present the largest cohort ever published of stage I seminoma patients followed on a surveillance program. The prognosis was excellent with a 10 year CSS of 99.6%. Prognostic factors for relapse were identified. The relapse rate after 5-years of follow-up was 1.4%. Surveillance should be the preferred option of management in stage I seminoma patients. Several international guidelines are now in agreement with this statement.

Seminoma and dysgerminoma: evidence for alignment of clinical trials and de-escalation of systemic chemotherapy

“…Both tumours are composed of uniform round primitive germ cells with clear cytoplasm and macronucleoli arranged in nests or cords and separated by thin fibrovascular septae containing lymphocytes (16,17). Vascular invasion is less common than other GCTs but is estimated to be present in 34% of seminomas (17) and may have prognostic significance (18). Although data are more limited in dysgerminoma, vascular invasion is also uncommon and has been described in approximately 20% of cases (19).…”

Uso de la quimioterapia en cáncer testicular de células germinales

“…Luego de la orquidectomía y que los estudios de estadificación complementarios confirman un estadio IA, existen tres opciones de conducta en este escenario: vigilancia activa, radioterapia o quimioterapia. La recomendación actual de preferencia en las guías de NCCN 5 y ESMO 6 es la vigilancia activa, dado que la supervivencia específica de cáncer para este grupo de pacientes es excelente, del 99,6% según el estudio de cohortes más largo conocido hasta la fecha 7 . La probabilidad de recaída sin tratamiento adyuvante está alrededor del 17% en una reciente revisión sistemática 8 y en el 19,5% en 10 años, según el estudio de Mortensen et al Desafortunadamente a la fecha no existen estudios clínicos aleatorizados que comparen vigilancia activa y tratamiento adyuvante 9 , lo cual hace que la toma de decisiones en este punto sea más un tema de establecer la facilidad para el seguimiento apropiado de los pacientes y una toma de decisiones informada y conjunta.…”