J Aparicio1, P Maroto2, X García del Muro3, A Sánchez-Muñoz4, J Gumà5, M Margelí6, A Sáenz7, N Sagastibelza8, D Castellano9, J A Arranz10, D Hervás11, R Bastús12, A Fernández-Aramburo13, J Sastre14, J Terrasa15, M López-Brea16, J Dorca17, D Almenar18, J Carles19, A Hernández20, J R Germà3. 1. Department of Medical Oncology, Hospital Universitario y Politécnico La Fe, Valencia japariciou@seom.org. 2. Department of Medical Oncology, Hospital de Sant Pau, Barcelona. 3. Department of Medical Oncology, Institut Català d'Oncologia, L'Hospitalet. 4. Department of Medical Oncology, Hospital Clínico Virgen de la Victoria, Málaga. 5. Department of Medical Oncology, Hospital Universitari Sant Joan, Reus. 6. Department of Medical Oncology, Hospital Germans Trias i Pujol, Badalona. 7. Department of Medical Oncology, Hospital Clínico, Zaragoza. 8. Department of Medical Oncology, Hospital Donostia, San Sebastián. 9. Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid. 10. Department of Medical Oncology, Hospital Universitario Gregorio Marañón, Madrid. 11. Biostatistics Unit, Instituto de Investigación Sanitaria La Fe, Valencia. 12. Department of Medical Oncology, Hospital Mutua de Terrassa, Barcelona. 13. Department of Medical Oncology, Complejo Hospitalario de Albacete, Albacete. 14. Department of Medical Oncology, Hospital Clínico San Carlos, Madrid. 15. Department of Medical Oncology, Hospital Son Espases, Palma de Mallorca. 16. Department of Medical Oncology, Hospital Universitario Marqués de Valdecilla, Santander. 17. Department of Medical Oncology, Institut Català d'Oncologia, Girona. 18. Department of Medical Oncology, Hospital Universitario Doctor Peset, Valencia. 19. Department of Medical Oncology, Hospital Universitario Vall d'Hebrón, Barcelona. 20. Department of Medical Oncology, Instituto Oncológico Guipúzcoa, San Sebastián, Spain.
Abstract
BACKGROUND: We aimed to analyze prognostic factors for relapse in stage I seminoma managed by either active surveillance or adjuvant chemotherapy, and to describe the long-term patterns of recurrence in both groups. PATIENTS AND METHODS: From 1994 to 2008, 744 patients were included in three consecutive, prospective risk-adapted studies by the Spanish Germ Cell Cancer Group. Low-risk patients were managed by surveillance and high-risk patients were given two courses of adjuvant carboplatin. Relapses were treated mainly with chemotherapy. Patient age, tumor size, histological variant, pT staging, rete testis invasion, and preoperative serum BHCG levels were assessed for prediction of disease-free survival (DFS). RESULTS: After a median follow-up of 80 months, 63 patients (11.1%) have relapsed: 51/396 (14.8%) on surveillance and 12/348 (3.2%) following adjuvant carboplatin. Actuarial overall 5-year DFS was 92.3% (88.3% for surveillance versus 96.8% for chemotherapy, P = 0.0001). Median time to relapse was 14 months. Most recurrences were located at retroperitoneum (86%), with a median tumor size of 26 mm. All patients were rendered disease-free with chemotherapy (92%), radiotherapy (5%), or surgery followed by chemotherapy (3%). A nomogram was developed from surveillance patients that includes two independent, predictive factors for relapse: rete testis invasion and tumor size (as a continuous variable). CONCLUSION: Long-term follow-up confirms the risk-adapted approach as an effective option for patients with stage I seminoma. The pattern of relapses after adjuvant chemotherapy is similar to that observed following surveillance. A new nomogram for prediction of DFS among patients on surveillance is proposed. Rete testis invasion and tumor size should be taken into account when considering the administration of adjuvant carboplatin. Prospective validation is warranted.
BACKGROUND: We aimed to analyze prognostic factors for relapse in stage I seminoma managed by either active surveillance or adjuvant chemotherapy, and to describe the long-term patterns of recurrence in both groups. PATIENTS AND METHODS: From 1994 to 2008, 744 patients were included in three consecutive, prospective risk-adapted studies by the Spanish Germ Cell Cancer Group. Low-risk patients were managed by surveillance and high-risk patients were given two courses of adjuvant carboplatin. Relapses were treated mainly with chemotherapy. Patient age, tumor size, histological variant, pT staging, rete testis invasion, and preoperative serum BHCG levels were assessed for prediction of disease-free survival (DFS). RESULTS: After a median follow-up of 80 months, 63 patients (11.1%) have relapsed: 51/396 (14.8%) on surveillance and 12/348 (3.2%) following adjuvant carboplatin. Actuarial overall 5-year DFS was 92.3% (88.3% for surveillance versus 96.8% for chemotherapy, P = 0.0001). Median time to relapse was 14 months. Most recurrences were located at retroperitoneum (86%), with a median tumor size of 26 mm. All patients were rendered disease-free with chemotherapy (92%), radiotherapy (5%), or surgery followed by chemotherapy (3%). A nomogram was developed from surveillance patients that includes two independent, predictive factors for relapse: rete testis invasion and tumor size (as a continuous variable). CONCLUSION: Long-term follow-up confirms the risk-adapted approach as an effective option for patients with stage I seminoma. The pattern of relapses after adjuvant chemotherapy is similar to that observed following surveillance. A new nomogram for prediction of DFS among patients on surveillance is proposed. Rete testis invasion and tumor size should be taken into account when considering the administration of adjuvant carboplatin. Prospective validation is warranted.
Authors: Rune A W van de Wetering; Stefan Sleijfer; Darren R Feldman; Samuel A Funt; George J Bosl; Ronald de Wit Journal: J Clin Oncol Date: 2018-02-01 Impact factor: 44.544
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Authors: Christian G Ruf; Stefanie Schmidt; Sabine Kliesch; Christoph Oing; David Pfister; Jonas Busch; Julia Heinzelbecker; Christian Winter; Friedemann Zengerling; Peter Albers; Karin Oechsle; Susanne Krege; Julia Lackner; Klaus-Peter Dieckmann Journal: World J Urol Date: 2022-09-15 Impact factor: 3.661