Risk Factors for Loss to Follow-up During Active Surveillance of Patients with Stage I Seminoma

Abstract

Objective: To elucidate the patterns and risk factors for loss to follow-up during active surveillance for Stage I seminoma. Methods: A total of 425 cases with Stage I seminoma underwent radical orchiectomy from 1985 to 2006 at 25 Japanese institutions, including 22 community hospitals and 3 university hospitals. The post-orchiectomy management selected was active surveillance for 186 patients, adjuvant radiotherapy for 182 patients and chemotherapy for 57 patients. The Kaplan -Meier method was used to estimate the recurrence-free survival and loss to follow-up rate. The risk factors for loss to follow-up were examined using Cox's proportional hazards model with multiple variables. Results: The 2-, 5-and 10-year loss to follow-up rates in the active surveillance group were 14.2, 37.8 and 71.3%, respectively, which were not significantly different in comparison with those in the active surveillance and adjuvant radiotherapy or chemotherapy groups. With regard to the active surveillance group, the multivariate analysis demonstrated that patients younger than 36 years at diagnosis, patients diagnosed since 2000 and patients treated at hospitals that enrolled more than 10 cases had a significant risk for loss to follow-up. No significant correlation between the loss to follow-up rate and pathological risk factors such as tumor size (4 versus .4 cm) and rete testis invasion (presence versus absence) was shown. Conclusions: The loss to follow-up rates beyond 5 years were unsatisfactorily high during active surveillance. Further approaches to improve the quality of active surveillance are needed, especially for high-risk patients such as those of younger age.

Compliance of males with stage 1 testicular germ cell tumours on an active surveillance protocol

“…Higher socioeconomic status is associated with better health indicators and improved health knowledge, which may in turn improve compliance with interventions such as active surveillance . The higher rates of compliance in older patients seen previously in the literature were not replicated in this data …”

“…Reports in the literature from single‐centre studies, such as this one, tend to have higher rates of compliance than those that obtain retrospective data from regional databases. Optimal compliance rates per year from analysis of the SEER Medicare data in the USA vary from 0% to 54%, whereas single institution compliance is reported as high as 97% . Rates of active surveillance are higher at this institution than average in Australia, and the location of this institution is within a higher than average income area.…”

“…Optimal compliance rates per year from analysis of the SEER Medicare data in the USA vary from 0% to 54%, whereas single institution compliance is reported as high as 97%. [16][17][18] Rates of active surveillance are higher at this institution than average in Australia, 15 and the location of this institution is within a higher than average income area. Higher socioeconomic status is associated with better health indicators and improved health knowledge, which may in turn improve compliance with interventions such as active surveillance.…”

“…A limitation in comparing compliance rates from different studies is that compliance is not defined uniformly across studies. The literature variably uses optimal (100%) compliance, rates of loss to follow up or a measure of adequate compliance similar to the one used in this article . There is a case for reporting adequate compliance rates, as this more meaningfully reflects real‐world practice and the effect of recall in this highly mobile and less health‐conscious population.…”

Treatment of Stage I Seminoma

“…Loss of follow-up is reported by US and Japanese teams. 15 The most common site of relapse for patients on surveillance is retroperitoneum and hence radiological imaging is necessary. The imaging frequency should be more in the first three years when the risk of relapse is high.…”