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.
Keywords
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Article info
Publication history
Published online: June 01, 2017
Accepted:
May 23,
2017
Received in revised form:
May 21,
2017
Received:
March 25,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
