Good Long-Term Outcomes With Surveillance for Stage I Nonseminoma Testicular Cancer
In a Danish population-based cohort study reported in Journal of Clinical Oncology, Daugaard and colleagues found that surveillance for stage I nonseminoma testicular cancer after orchiectomy was associated with high cure rate and low treatment burden over long-term follow-up.
Study Details
The study involved 1,226 patients with stage I nonseminoma germ cell cancer, including 170 (14%) with vascular invasion, treated between January 1984 and December 2007. Follow-up included 5 or 6 computed tomography (CT) scans at 4, 8, 12, 18, 24, 36, and 60 months after orchiectomy, measurement of tumor markers at 1 year, 4 visits during year 2, and 2 visits per year during years 3 to 5.
Relapse Risk
Median follow-up was 180 months (range = 1–346 months). Risks of relapse at 6 months and 1, 2, and 5 years were 18.5%, 24.9%, 29.4%, and 30.6%. Fifty-nine percent of all relapses were detected within the first 6 months (70% in patients with vascular invasion), and 80% were detected within the first year.
Median time to relapse was 5 months (range =1–308 months). Early relapses were detected mainly by increases in tumor markers, and late relapses were detected by CT scans. Relapse after 5 years occurred in 0.5% of the whole cohort and in 1.6% of patients with relapse.
The presence of vascular invasion, embryonal carcinoma, and rete testis invasion in the testicular primary identified a group with a relapse risk of 50%. In the absence of risk factors, risk of relapse was 12%. The majority of relapses (94%) were in patients in the good prognostic group according to the International Germ Cell Cancer Collaborative Group classification.
Treatment
In total, 356 patients were treated for relapse with bleomycin/etoposide/cisplatin, with complete response achieved in 88%. In 27 patients with a second relapse, treatment produced complete response in 78%. In total, 8% of patients underwent surgery apart from orchiectomy. Disease-specific survival at 15 years was 99.1%.
The investigators concluded: “A surveillance policy for patients with stage I [nonseminoma germ cell cancer] is a safe approach associated with an excellent cure rate and an overall low treatment burden despite a high relapse rate in a small group of patients. We recommend surveillance for patients with stage I [nonseminoma germ cell cancer] with immediate systemic treatment at relapse.”
The study was supported by Danish Regions, Danish Cancer Society, and Preben and Anna Simonsens Foundation.
Gedske Daugaard, MD, DMSc, of Rigshospitalet, Copenhagen, is the corresponding author for the Journal of Clinical Oncology article.
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