Active Surveillance for Clinical Stage I Testicular Cancer Associated With ‘Excellent’ Outcomes
In a retrospective study reported in the Journal of Clinical Oncology, Kollmannsberger et al found that active surveillance for patients with clinical stage I testicular cancer is associated with very good outcomes. Most relapses occurred within 2 years of orchiectomy in patients with nonseminoma and within 3 years in those with seminoma, and late and advanced-stage relapses were infrequent.
Study Details
The study included data from 2,483 patients, including 1,139 with nonseminoma and 1,344 with seminoma, managed with active surveillance, with the majority being treated between 1998 and 2010. Participating institutions included the Swedish/Norwegian Testicular Cancer group, Princess Margaret Cancer Center, British Columbia Cancer Agency/Oregon, Bart’s Cancer Institute (London), and the University of Oxford/Churchill Hospital.
Relapses
Relapse occurred in 221 (19%) of nonseminoma patients and 173 (13%) of seminoma patients. Median time to relapse was 4 months (range = 2–61 months) in those with lymphovascular invasion–positive nonseminoma, 8 months (range = 2–77 months) in those with lymphovascular invasion–negative nonseminoma, and 14 months (range = 2-84 months) for those with seminoma. Overall, 90% of nonseminoma relapses occurred within 2 years after orchiectomy and 92% of seminoma relapses occurred within 3 years. Relapse after 3 years occurred in only 1% of nonseminoma patients who were disease-free at 3 years.
International Germ Cell Collaborative Group good-risk features were exhibited by 90% of nonseminoma relapses and 99% of seminoma relapses. All late recurrences were cured with standard therapy.
Relapse Detection
The proportions of relapses detected by computed tomography and tumor markers were 87% and 3% in patients with seminoma, 48% and 38% in those with lymphovascular invasion–negative nonseminoma, and 41% and 61% in those with lymphovascular invasion–positive nonseminoma.
Survival
After median follow-up of 63 months in patients with nonseminoma, 98% were free of disease; 3 (< 1%) died of disease, 2 (< 1%) died from treatment-related complications, and 11 (< 1%) died from unrelated causes. After median follow-up of 52 months in patients with seminoma, 99% were free of disease; 1 (<1%) died from treatment-related complications and 16 (1%) died from unrelated causes. In the entire cohort, 5-year disease-specific survival was 99.7% (95% confidence interval = 99.24%–99.93%).
The investigators concluded: “Active surveillance for [clinical stage I] testis cancer leads to excellent outcomes. The vast majority of relapses occur within 2 years of orchiectomy for [clinical stage I] nonseminoma and within 3 years for [clinical stage I] seminoma. Late and advanced stage relapse are rarely seen. These data may inform further refinement of rationally designed surveillance schedules.”
Christian Kollmannsberger, MD, of University of British Columbia, is the corresponding author for the Journal of Clinical Oncology article. Dr. Kollmannsberger and Torgrim Tandstad, MD, PhD, ofSt. Olavs University Hospital, Trondheim, contributed equally as first authors.
Tom Powles, MBBS, MRCP, MD, reported honoraria from GlaxoSmithKline, Pfizer, and Astellas Pharma.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
