Friedemann Zengerling1, Frank Kunath2, Katrin Jensen3, Christian Ruf4, Stefanie Schmidt5, Annabel Spek6. 1. Department of Urology, University Hospital of Ulm, Ulm, Germany; UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany. Electronic address: friedemann.zengerling@uniklinik-ulm.de. 2. Department of Urology, University Hospital of Erlangen, Erlangen, Germany; UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany. 3. Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany. 4. Department of Urology, Federal Armed Forces Central Hospital of Koblenz, Koblenz, Germany. 5. UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany. 6. UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany; Department of Urology, University Hospital of Munich, München, Germany.
Abstract
OBJECTIVE: To systematically evaluate evidence on prognostic factors for tumor recurrence in patients with clinical stage I seminoma undergoing surveillance. METHODS: Systematic literature search conducted of Medline, Web of Science, Cochrane Library, and the conference proceedings of the ASCO, AUA, and EAU meetings (last search: October 2016), according to our prospectively registered protocol (PROSPERO registration number CRD42014009434). Identified records were reviewed according to the Cochrane Method Group of Prognosis Reviews recommendations and the PRISMA reporting guideline. Study quality was appraised with the Quality in Prognosis Studies (QUIPS) tool. RESULTS: Nineteen studies reporting on 26 potential prognostic factors were included in our analysis. Among the most frequently reported factors, tumor size (continuous or dichotomized) was significantly associated with relapse in 10/14 studies with a hazard ratio (HR) ranging from 1.33 (95% confidence interval [CI]: 1.14-1.56) to 3.17 (95% CI: 1.08-9.26). Rete testis invasion was significantly associated with relapse in only 4/13 studies with a HR ranging from 1.18 (95% CI: 0.92-1.51) to 1.36 (95% CI: 0.81-2.28). Lymphovascular invasion, young age, and preoperative HCG level had no association with relapse. Our findings are limited by heterogeneity of study designs, potential reporting bias, and moderate-to-poor study quality. CONCLUSION: In stage I seminoma, tumor size is the most valuable prognostic factor on which to base relapse risk and to counsel patients about adjuvant treatment. Large tumor size was defined quite inhomogenously among the included studies, so no distinct cutoff value for tumor size can be recommended. Other potential prognostic factors including rete testis invasion play a minor role in stage I seminoma.
OBJECTIVE: To systematically evaluate evidence on prognostic factors for tumor recurrence in patients with clinical stage I seminoma undergoing surveillance. METHODS: Systematic literature search conducted of Medline, Web of Science, Cochrane Library, and the conference proceedings of the ASCO, AUA, and EAU meetings (last search: October 2016), according to our prospectively registered protocol (PROSPERO registration number CRD42014009434). Identified records were reviewed according to the Cochrane Method Group of Prognosis Reviews recommendations and the PRISMA reporting guideline. Study quality was appraised with the Quality in Prognosis Studies (QUIPS) tool. RESULTS: Nineteen studies reporting on 26 potential prognostic factors were included in our analysis. Among the most frequently reported factors, tumor size (continuous or dichotomized) was significantly associated with relapse in 10/14 studies with a hazard ratio (HR) ranging from 1.33 (95% confidence interval [CI]: 1.14-1.56) to 3.17 (95% CI: 1.08-9.26). Rete testis invasion was significantly associated with relapse in only 4/13 studies with a HR ranging from 1.18 (95% CI: 0.92-1.51) to 1.36 (95% CI: 0.81-2.28). Lymphovascular invasion, young age, and preoperative HCG level had no association with relapse. Our findings are limited by heterogeneity of study designs, potential reporting bias, and moderate-to-poor study quality. CONCLUSION: In stage I seminoma, tumor size is the most valuable prognostic factor on which to base relapse risk and to counsel patients about adjuvant treatment. Large tumor size was defined quite inhomogenously among the included studies, so no distinct cutoff value for tumor size can be recommended. Other potential prognostic factors including rete testis invasion play a minor role in stage I seminoma.
Authors: Friedemann Zengerling; Dirk Beyersdorff; Jonas Busch; Julia Heinzelbecker; David Pfister; Christian Ruf; Christian Winter; Peter Albers; Sabine Kliesch; Stefanie Schmidt Journal: World J Urol Date: 2022-07-29 Impact factor: 3.661
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