Prognostic factors for relapse in stage I seminoma: a new nomogram derived from three consecutive, risk-adapted studies from the Spanish Germ Cell Cancer Group (SGCCG)

Aparicio, Jorge; Maroto, Pablo; Muro, Xavier García del; Sánchez-Muñoz, Alfonso; Gumà, Josep; Margelı́, Mireia; Saenz, A.; Sagastibelza, N.; Castellano, Daniel; Arranz, José Ángel; Hervás, David; Bastús, R.; Fernández-Aramburo, Antonio; Sastre, Javier; Terrasa, Josefa; López‐Brea, Marta; Dorca, Joan; Almenar, D.; Carles, Joan; Hernández, A.; Germà, J.R.

doi:10.1093/annonc/mdu437

Cited by 107 publications

(71 citation statements)

References 19 publications

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“…According to this finding, a less intensive follow-up schedule (i.e., 4–5 CT scans over 5 years) could be used and is now recommended by our group. Based on results from the present and previous SGCCG studies [8-10, 12, 14], with a predicted relapse rate on surveillance of 20–25% versus 3–5% after 2 cycles of carboplatin, we estimate that 5–6 patients with RTI are needed-to-treat to prevent 1 relapse. The study was prematurely closed due to slow patient accrual.…”

Section: Discussionmentioning

confidence: 85%

“…The SGCCG has demonstrated that they can guide the use of adjuvant chemotherapy in the setting of a risk-adapted approach [8-10]. In fact, we have developed a predictive nomogram to estimate 3-year DFS based on these parameters [12]. In all SGCCG studies, vascular invasion was significantly more common in patients with other risk factors (RTI and/or tumor size > 4 cm), probably reflecting a more advanced disease extension.…”

Section: Discussionmentioning

confidence: 99%

“…In all SGCCG studies, vascular invasion was significantly more common in patients with other risk factors (RTI and/or tumor size > 4 cm), probably reflecting a more advanced disease extension. However, in the multivariate analysis of prognostic factors, vascular invasion did not reach a statistically significant, independent predictive value [12]. A recent systematic review showed that tumor size (better considered as a continuous variable) was positively associated with relapse rate in 10 of 14 studies, whereas RTI was only positively associated with relapse rate in 4 of 13 studies [13].…”

Section: Discussionmentioning

confidence: 99%

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A Risk-Adapted Approach to Patients with Stage I Seminoma according to the Status of Rete Testis: The Fourth Spanish Germ Cell Cancer Group Study

et al. 2018

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Objective: The aim of this study was to assess a risk-adapted strategy for stage I seminoma guided by the presence of rete testis invasion. Methods: Between January 2013 and December 2015, a total of 135 consecutive patients with stage I seminoma from 18 Spanish tertiary hospitals were included in a prospective multicenter study. Median patient age was 38 years (range 22–60). Preoperative beta-human chorionic gonadotropin was elevated in 9.6% of patients. Rete testis invasion was present in 47.4% of patients. After orchiectomy, subjects with rete testis invasion were treated with 2 courses of adjuvant carboplatin (area under the curve of 7, with 21-day interval). Those without this risk factor were managed by surveillance. Disease-free survival (DFS) and overall survival (OS) were estimated with the Kaplan-Meier method. Results: After a median follow-up time of 33 months, only 6 relapses were recorded (5 on surveillance, 1 after carboplatin). These cases were rescued with BEP or EP chemotherapy, and all 135 patients are currently disease free without sequelae. Three-year DFS was 92.0 and 98.2% for patients on surveillance and after carboplatin, respectively. Three-year OS was 100%. Conclusion: A risk-adapted approach based on rete testis invasion as a single risk factor is feasible and yielded an excellent outcome with a 3-year DFS of 94.9%.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A Risk-Adapted Approach to Patients with Stage I Seminoma according to the Status of Rete Testis: The Fourth Spanish Germ Cell Cancer Group Study

et al. 2018

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“…7,10,11 A pooled analysis of these studies reported that at median follow-up of 80 months, 14.8% patients on surveillance and 3.2% patients treated with adjuvant carboplatin relapsed. Actuarial overall 5-year DiseaseFree Survival (DFS) was 92.3% (88.3% for surveillance vs. 96.8% for chemotherapy, p=0.0001).…”

Section: Risk Factors For Relapsementioning

confidence: 99%

“…The relapse rate of patients on surveillance is 11.1-27%. 7,[12][13][14] A close follow-up and early detection of recurrence is necessary for a successful salvage treatment. This requires frequent imaging and good patient compliance.…”

Section: Surveillancementioning

confidence: 99%

Treatment of Stage I Seminoma

Anjanappa¹,

Kainickal²,

James³

2015

Cancer Stud Mol Med Open J

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Stage I testicular seminoma is a curable condition. The primary treatment is high inguinal orchiectomy. The treatment options after surgery includes radiotherapy, chemotherapy with single agent carboplatin and active surveillance. Radiotherapy has evolved over the past decades with reduced treatment volume and radiation dose without compromising the outcome. Para aortic strip radiation 20 Gy in 10 fractions is equivalent to single agent carboplatin. Active surveillance is an acceptable approach for patients without adverse factors. There is no data comparing treatment versus active surveillance till date. This article reviews the evidences for each approach.

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Early‐stage (stage I) seminoma

Daneshmand

Hugen

2018

Evidence‐Based Urology

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Prognostic factors for relapse in stage I seminoma: a new nomogram derived from three consecutive, risk-adapted studies from the Spanish Germ Cell Cancer Group (SGCCG)

Cited by 107 publications

References 19 publications

A Risk-Adapted Approach to Patients with Stage I Seminoma according to the Status of Rete Testis: The Fourth Spanish Germ Cell Cancer Group Study

A Risk-Adapted Approach to Patients with Stage I Seminoma according to the Status of Rete Testis: The Fourth Spanish Germ Cell Cancer Group Study

Treatment of Stage I Seminoma

Early‐stage (stage I) seminoma

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