Martina Ondrusova1, Iveta Waczulikova2, Viera Lehotska3, Tomas Zeleny4, Dalibor Ondrus5. 1. St Elizabeth University of Health and Social Sciences, Bratislava, Slovak Republic; Department of Epidemiology and Biostatistics, Pharm-In, Ltd, Bratislava, Slovak Republic. 2. Department of Nuclear Physics and Biophysics, Faculty of Mathematics, Physics, and Informatics, Comenius University, Bratislava, Slovak Republic. 3. Second Department of Radiology, Faculty of Medicine, Comenius University, St Elisabeth Cancer Institute, Bratislava, Slovak Republic. 4. Institute for Hygiene and Epidemiology, First Faculty of Medicine, Charles University, Prague, Czech Republic. 5. First Department of Oncology, Faculty of Medicine, Comenius University, St Elisabeth Cancer Institute, Bratislava, Slovak Republic. Electronic address: dalibor.ondrus@ousa.sk.
Abstract
BACKGROUND: Surveillance after orchiectomy alone has become popular in the management of clinical stage I nonseminomatous germ cell testicular tumors (CSI NSGCTT). Efforts to identify patients at high risk of disease progression led to a search for risk factors in CSI NSGCTT. The aim of this study was to analyze a 25-year single-center experience with risk-adapted therapeutic approaches-active surveillance (AS) versus adjuvant chemotherapy (ACT). PATIENTS AND METHODS: From January 1992 to January 2017, a total of 485 patients with CSI NSGCTT were stratified into the AS group (low-risk patients) and the ACT group (high-risk patients). Differences between relapse rates and overall survival rates in these groups were statistically analyzed. RESULTS: In the AS group, relapse occurred in 52 (17.3%) of 301 patients with a median follow-up of 7.2 months (range, 2-86 months). Six (2.0%) patients of this group died, with a median follow-up of 34.3 months (range, 11-102 months). In the ACT group, relapse occurred in 2 (1.1%) of 184 patients with a median follow-up of 56.2 months (range, 42-70 months). One (0.54%) patient died at 139.4 months following orchiectomy. The relapse rate for the AS group was 16.7 times higher than that for the ACT group. The groups did not differ in overall survival. The 3-year overall survival of all patients with CSI NSGCTT was 99.1% (95% confidence interval, 97.7%-99.7%). Three of a total of 7 deaths occurred thereafter. CONCLUSIONS: The policy of AS is recommended only in patients with low-risk CSI NSGCTT.
BACKGROUND: Surveillance after orchiectomy alone has become popular in the management of clinical stage I nonseminomatous germ cell testicular tumors (CSI NSGCTT). Efforts to identify patients at high risk of disease progression led to a search for risk factors in CSI NSGCTT. The aim of this study was to analyze a 25-year single-center experience with risk-adapted therapeutic approaches-active surveillance (AS) versus adjuvant chemotherapy (ACT). PATIENTS AND METHODS: From January 1992 to January 2017, a total of 485 patients with CSI NSGCTT were stratified into the AS group (low-risk patients) and the ACT group (high-risk patients). Differences between relapse rates and overall survival rates in these groups were statistically analyzed. RESULTS: In the AS group, relapse occurred in 52 (17.3%) of 301 patients with a median follow-up of 7.2 months (range, 2-86 months). Six (2.0%) patients of this group died, with a median follow-up of 34.3 months (range, 11-102 months). In the ACT group, relapse occurred in 2 (1.1%) of 184 patients with a median follow-up of 56.2 months (range, 42-70 months). One (0.54%) patient died at 139.4 months following orchiectomy. The relapse rate for the AS group was 16.7 times higher than that for the ACT group. The groups did not differ in overall survival. The 3-year overall survival of all patients with CSI NSGCTT was 99.1% (95% confidence interval, 97.7%-99.7%). Three of a total of 7 deaths occurred thereafter. CONCLUSIONS: The policy of AS is recommended only in patients with low-risk CSI NSGCTT.
Authors: Klaus-Peter Dieckmann; Tomas Pokrivcak; Lajos Geczi; David Niehaus; Inken Dralle-Filiz; Cord Matthies; Tamas Dienes; Stefanie Zschäbitz; Pia Paffenholz; Tanja Gschliesser; Renate Pichler; Michal Mego; Pia Bader; Friedemann Zengerling; Julia Heinzelbecker; Philipp Krausewitz; Susanne Krege; Gaetano Aurilio; Cem Aksoy; Marcus Hentrich; Christoph Seidel; Péter Törzsök; Tim Nestler; Matthaeus Majewski; Andreas Hiester; Tomas Buchler; Sonia Vallet; Hana Studentova; Sandra Schönburg; Dora Niedersüß-Beke; Julia Ring; Emanuela Trenti; Axel Heidenreich; Christian Wülfing; Hendrik Isbarn; Uwe Pichlmeier; Martin Pichler Journal: Ther Adv Med Oncol Date: 2022-03-31 Impact factor: 8.168