Prognostic factors for tumor recurrence in patients with clinical stage I seminoma undergoing surveillance—A systematic review

Zengerling, Friedemann; Kunath, Frank; Jensen, Katrin; Ruf, Christian; Schmidt, Stefanie; Spek, Annabel

doi:10.1016/j.urolonc.2017.06.047

Cited by 60 publications

(45 citation statements)

References 40 publications

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“…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]. However, RTI status was not analyzed in at least 25–33% of patients in some of the studies.…”

Section: Discussionmentioning

confidence: 99%

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: 99%

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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“…At present, the histopathological risk factors in the primary tumour employed to define high-risk group in CS I patients are not very well founded and do not constitute a good basis for decision on adjuvant treatment. Existing studies are often hampered by heterogeneous study populations,7 11–16 substantial amount of missing data,1 3 4 13 17 limited statistical power,13 18 19 lack of central pathology review1 3 7 13 17 19 and with potential variable reporting of the histopathological risk factors 20–24. Further, the prognostic power of the risk factors is low.…”

Section: Introductionmentioning

confidence: 99%

“…In seminoma, a clear correlation between increasing tumour size and risk of relapse has been reported 3 4 13 16 17. A cut-off value of 4 cm is the most frequently studied, but evidence to justify this cut-off is lacking 13 14. Even in a ‘high-risk setting’ (tumours 6 cm or larger) adjuvant radiotherapy led to overtreatment in two-thirds of the patients 25.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic factors for relapse in patients with clinical stage I testicular cancer: protocol for a Danish nationwide cohort study

et al. 2019

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IntroductionApproximately one-fourth of patients with clinical stage I testicular germ cell cancer will relapse within 5 years of follow-up. Certain histopathological features in the primary tumour have been associated with an increased risk of relapse. The available evidence on the prognostic value of the risk factors, however, is hampered by heterogeneity of the study populations included and variable reporting of the histopathological features. The aim of this study is to identify pathological risk factors for relapse in an unselected large nationwide cohort of patients with stage I disease.Methods and analysisAll incident cases of stage I testicular germ cell cancer diagnosed in Denmark between 2013 and 2018 will be identified using the nationwide prospective Danish Testicular Cancer (DaTeCa) database. Archived microscopic slides from the orchiectomy specimens will be retrieved through linkage to the Danish Pathology Data Bank and reviewed blinded to the clinical outcome. The DaTeCa database includes 960 stage I seminoma patients with expected 185 relapses and 480 patients with stage I non-seminoma with expected 150 relapses. A minimum follow-up period of 3 years of all patients will be ensured. Predefined prognostic variables will be investigated with regard to relapse in univariable and multivariable analysis using the Cox proportional hazards model.Ethics and disseminationThis study protocol has been approved by the Regional Ethics Committee (Region Zealand, Denmark) and the Danish Data Protection Agency. All data will be managed confidentially according to legislation. Study results will be presented at international conferences and published in peer-review journals.

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“…However, its significance as a prognostic marker remains controversial. In a recently published systematic review, tumour size positively correlated with relapse in ten of the 14 included studies, whereas rete testis invasion was associated with tumour relapse in only four of the 12 included studies 6 . In a review by Boormans et al, there was no sufficient evidence for both factors 7 .…”

Section: Discussionmentioning

confidence: 97%

The metastatic potential of seminomatous germ cell tumours is associated with a specific microRNA pattern

et al. 2020

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Background Seminomatous germ cell tumours (SGCT) are the most frequent malignancy in young men. Reliable prognostic biomarkers for the prediction of metastasis at diagnosis and the risk of relapse in clinical stage I (CSI) are lacking. Adjuvant therapies carry a risk of overtreatment, whereas salvage therapies have a risk of high toxicities. Thus, the identification of reliable prognostic biomarkers is highly desirable to identify patients who will benefit from early adjuvant treatment. MicroRNAs (miRNAs) regulate tumour development and progression, and their potential as biomarkers has already been proven in a variety of malignancies. Objectives The aim of our study was to define a specific miRNA expression pattern that discriminates metastatic from non‐metastatic primary SGCT. Materials and methods Total RNA was isolated from 24 formalin‐fixed paraffin‐embedded (FFPE) primary SGCT tumours (10 non‐metastatic, five metachronously and nine synchronously metastatic) and from 10 normal testicular tissue samples. Microarray analysis was performed for global miRNA expression profiling. The results were validated by quantitative real‐time polymerase chain reaction (qRT‐PCR). Statistical analysis was performed using SPSS. Results Microarray analyses revealed a specific miRNA pattern that distinguishes metastatic from non‐metastatic SGCT. Sixty‐three miRNAs were differentially expressed in metastatic compared to non‐metastatic tumours (P < .01). Microarray results were confirmed by qRT‐PCR for three out of five selected miRNAs (miR‐29c‐5p, miR‐506‐3p and miR‐371a‐5p; P < .05). All five miRNAs (miR‐29c‐5p, miR‐506‐3p, miR‐1307‐5p, miR‐371a‐5p and miR‐371a‐3p) showed differential expression between tumour and normal tissues (P < .05). Conclusion Metastatic primary SGCTs are characterized by a specific miRNA expression pattern. Therefore, specific miRNAs could represent a new tool to predict the metastatic potential in SGCT patients.

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Prognostic factors for tumor recurrence in patients with clinical stage I seminoma undergoing surveillance—A systematic review

Cited by 60 publications

References 40 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

Prognostic factors for relapse in patients with clinical stage I testicular cancer: protocol for a Danish nationwide cohort study

The metastatic potential of seminomatous germ cell tumours is associated with a specific microRNA pattern

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