Non-risk-adapted surveillance in clinical stage i nonseminomatous germ cell tumors: The Princess Margaret Hospital's experience

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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. © 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.

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Sturgeon, J. F., Moore, M. J., Kakiashvili, D. M., Duran, I., Anson-Cartwright, L. C., Berthold, D. R., … Jewett, M. A. (2011). Non-risk-adapted surveillance in clinical stage i nonseminomatous germ cell tumors: The Princess Margaret Hospital’s experience. European Urology, 59(4), 556–562. https://doi.org/10.1016/j.eururo.2010.12.010

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