Details

Autor(en) / Beteiligte

• Sturgeon, Jeremy F
• Moore, Malcolm J
• Kakiashvili, David M
• Duran, Ignacio
• Anson-Cartwright, Lynn C
• Berthold, Dominik R
• Warde, Padraig R
• Gospodarowicz, Mary K
• Alison, Ruth E
• Liu, Justin
• Ma, Clement
• Pond, Greg R
• Jewett, Michael A

Titel

Non–Risk-Adapted Surveillance in Clinical Stage I Nonseminomatous Germ Cell Tumors: The Princess Margaret Hospital’s Experience

Ist Teil von

• European urology, 2011-04, Vol.59 (4), p.556-562

Ort / Verlag

Kidlington: Elsevier B.V

Erscheinungsjahr

2011

Quelle

Access via ScienceDirect (Elsevier)

Beschreibungen/Notizen

• Abstract Background Since 1981 Princess Margaret Hospital has used initial active surveillance (AS) with delayed treatment at relapse as the preferred management for all patients with clinical stage I nonseminomatous germ cell tumors (NSGCT). Objective Our aim was to report our overall AS experience and compare outcomes over different periods using this non–risk-adapted approach. Design, setting, and participants Three hundred and seventy-one patients with stage I NSGCT were managed by AS from 1981 to 2005. For analysis by time period, patients were divided into two cohorts by diagnosis date: initial cohort, 1981–1992 ( n = 157), and recent cohort, 1993–2005 ( n = 214). Intervention Patients were followed at regular intervals, and treatment was only given for relapse. Measurements Recurrence rates, time to relapse, risk factors for recurrence, disease-specific survival, and overall survival were determined. Results and limitations With a median follow-up of 6.3 yr, 104 patients (28%) relapsed: 53 of 157 (33.8%) in the initial group and 51 of 214 (23.8%) in the recent group. Median time to relapse was 7 mo. Lymphovascular invasion ( p < 0.0001) and pure embryonal carcinoma ( p = 0.02) were independent predictors of recurrence; 125 patients (33.7%) were designated as high risk based on the presence of one or both factors. In the initial cohort, 66 of 157 patients (42.0%) were high risk and 36 of 66 patients (54.5%) relapsed versus 17 of 91 low-risk patients (18.7%) ( p < 0.0001). In the recent cohort, 59 of 214 patients (27.6%) were high risk and 29 of 59 had a recurrence (49.2%) versus 22 of 155 low-risk patients (14.2%) ( p < 0.0001). Three patients (0.8%) died from testis cancer. The estimated 5-yr disease-specific survival was 99.3% in the initial group and 98.9% in the recent one. Conclusions Non–risk-adapted surveillance is an effective, simple strategy for the management of all stage I NSGCT.