Surveillance in stage I testicular cancer

Abstract

Treatment results on 695 stage I testicular cancer patients followed with surveillance are described. Seminoma (SGCT) was present in 394 patients and nonseminoma (NSGCT) in 301 patients. Relapses were detected in 155 patients (22%), in 69 patients with SGCT (17%) and 86 with NSGCT (29%). In patients with vascular invasion, relapse was detected in 54% of patients with NSGCT and 38% of patients with SGCT. Time to relapse was median 13 months (range 1 to 84 months) for SGCT and 5 months (range 1 to 171 months) for NSGCT. Forty-nine percent of relapses in SGCT patients were seen within the first year, 87% of the relapses were diagnosed within the first two years, and 98% of the relapses were detected within 5 years. The figures for NSGCT were 80%, 89% and 95%, respectively. Forty-five patients had carcinoma in situ in the contralateral testis, 62% had this together with a seminoma in the other testis. Ten patients died during the follow-up period. None of these deaths were caused by the germ cell tumour or the treatment. The overall survival for patients with stage I disease is 98.6%, and the cause specific survival 100%.

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

“…Daugaard et al (10) reported that 23 of 695 patients (3.3%) with Stage I testicular cancer including non-seminoma were LTFU before 5 years. In a longer-term observation, Choo et al (11) identified only three (3.4%) patients LTFU among 88 Stage I seminoma patients with a median follow-up of 12 years.…”

Canadian consensus guidelines for the management of testicular germ cell cancer

“…[13][14][15][16][17][18][19][20] The data in these series are now mature and relapse rates have consistently been reported to be about 15% in unselected patients with stage I disease. The predominant site of relapse in all studies was in the paraaortic lymph nodes; 41 of 49 (82%) of relapses in the Danish Testicular Cancer Study Group (DATECA) study and 57 of 64 (85%) in the Princess Margaret Hospital (PMH) series.…”

“…The survival outcomes are summarized in Table 5. 13,[45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63] The presence of microscopic vascular or lymphatic invasion in the primary tumour is the most important factor predicting relapse and the presence or absence of this factor has been used to divide patients: those with high-risk disease (a third of the cases) who have about a 50% risk of relapse, and those with low-risk disease who have about a 15% to 20% risk of relapse. 45 …”

Evidence‐based guidelines for following stage 1 seminoma

“…[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Three were randomized controlled trials, 9 were phase 2 trials, and 5 were from prospective institutional databases. For purposes of summary data generation, these studies included a total of 5561 patients ( Table 2).…”