A novel surveillance protocol for stage I nonseminomatous germ cell testicular tumours

Abstract

RESULTSThe median (range) follow-up was 38 (6-265) months; the relapse rate was 24% and all occurred before 23 months, with 87% diagnosed within the first year. Platinumbased chemotherapy was given to patients with relapse, and surgery used after chemotherapy in seven. Among all the risk factors, an embryonal carcinoma component was the only significant predictor of relapse. The overall survival rate was 99%. CONCLUSIONThe presence of embryonal carcinoma in the primary pathology is the only risk factor determining the relapse rate of the present surveillance policy for stage I NSGCTs. The overall survival was no different from those reported for retroperitoneal lymph node dissection and primary chemotherapy. Decreasing the frequency of CT in the first year and totally eliminating it after 1 year reduces the cost of surveillance. The possible compliance problems of patients are also minimized, without changing the overall survival. This surveillance protocol for patients with stage I NSGCT has reduced costs and provided a better quality of life for the patients, without jeopardizing the final outcome.

Datasets for the reporting of neoplasia of the testis: recommendations from the International Collaboration on Cancer Reporting

“…As well as the percentage of embryonal carcinoma as a core data item, the approximate percentages of other tumour elements should be given. LVI, embryonal carcinoma and yolk sac tumour were risk factors for relapse in a study of 132 patients . A second study showed that 25 of 85 men who had predominantly embryonal carcinoma histology relapsed .…”

Current Concepts in Management of Stage I NSGCT

“…Various studies have been designed to reduce the number of CT scans during the surveillance strategy [31,32]. The prospective-randomized Medical Research Council Trial TE08 was initiated which compared the diagnostic efficacy of two versus five CT scans during the first 2 years of follow-up to detect the number of patients who have intermediate and poor prognosis disease at relapse [32].…”

Prognostic features and markers for testicular cancer management

“…The study concluded that the presence of embryonal carcinoma component was the only significant risk factor that could determine disease relapse. [38] Another group that evaluated 10-year results of a surveillance study of clinical stage I non-seminomatous cancer showed that 25 of 85 men experienced relapse after a median disease-free interval of seven months. [39] All 25 patients had predominant embryonal carcinoma histology in their primary tumor which was significantly associated with disease relapse (p=0.008).…”