Changing Practice Evaluation—Stage 1 Seminoma: Outcomes With Adjuvant Treatment Versus Surveillance: Risk Factors for Recurrence and Optimizing Follow-up Protocols—Experience From a Supraregional Center
Stage 1 seminomas treated by orchiectomy (501 cases) were analyzed to identify the risk factors for recurrence and methods of relapse detection. Rete testis invasion and, more strongly, stromal rete testis invasion increased the risk of relapse. Most recurrences were identified within 2 years of sur...
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| Vydané v: | Clinical genitourinary cancer Ročník 16; číslo 3; s. 240 - 244 |
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| Hlavní autori: | , , , , , , , , , , , |
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| Jazyk: | English |
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Elsevier Inc
01.06.2018
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| Abstract | Stage 1 seminomas treated by orchiectomy (501 cases) were analyzed to identify the risk factors for recurrence and methods of relapse detection. Rete testis invasion and, more strongly, stromal rete testis invasion increased the risk of relapse. Most recurrences were identified within 2 years of surgery by routine surveillance computed tomography scans.
Stage 1 seminoma is frequently cured by radical orchiectomy; however, the management strategies after this diagnosis vary in terms of the use of adjuvant treatment and the nature of the follow-up protocols. We analyzed stage 1 seminomas treated in the Thames Valley Cancer Network for outcomes to determine whether any factors are predictive of recurrence. We also studied relapses to determine the optimal follow-up schedule and protocol.
Data were obtained from centers within the Thames Valley Cancer Network for a 12-year period from 2004 to 2016. We identified 501 patients with stage 1 seminoma.
Relapses occurred in 6.2% of the patients receiving adjuvant treatment and 6.1% of those who did not. The only statistically significant predictive factor identified for relapse was rete testis invasion, and the risk was greater when only stromal rete invasion was included, rather than pagetoid as well. A trend was seen toward an increased risk with increased tumor size, but the difference was not statistically significant. Recurrences developed within the first 2 years after surgery in nearly 75% of cases and were identified through surveillance computed tomography scans in 54.8% of the patients. All relapses were treated curatively.
Active surveillance leads to excellent outcomes for stage 1 seminoma; however, adjuvant treatment should be reserved for those with high-risk disease. Follow-up schedules should include computed tomography imaging during the first 3 years, long-term measurement of tumor markers, and mechanisms for patients to be seen promptly should symptoms of tumor recurrence occur. |
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| AbstractList | Stage 1 seminoma is frequently cured by radical orchiectomy; however, the management strategies after this diagnosis vary in terms of the use of adjuvant treatment and the nature of the follow-up protocols. We analyzed stage 1 seminomas treated in the Thames Valley Cancer Network for outcomes to determine whether any factors are predictive of recurrence. We also studied relapses to determine the optimal follow-up schedule and protocol.
Data were obtained from centers within the Thames Valley Cancer Network for a 12-year period from 2004 to 2016. We identified 501 patients with stage 1 seminoma.
Relapses occurred in 6.2% of the patients receiving adjuvant treatment and 6.1% of those who did not. The only statistically significant predictive factor identified for relapse was rete testis invasion, and the risk was greater when only stromal rete invasion was included, rather than pagetoid as well. A trend was seen toward an increased risk with increased tumor size, but the difference was not statistically significant. Recurrences developed within the first 2 years after surgery in nearly 75% of cases and were identified through surveillance computed tomography scans in 54.8% of the patients. All relapses were treated curatively.
Active surveillance leads to excellent outcomes for stage 1 seminoma; however, adjuvant treatment should be reserved for those with high-risk disease. Follow-up schedules should include computed tomography imaging during the first 3 years, long-term measurement of tumor markers, and mechanisms for patients to be seen promptly should symptoms of tumor recurrence occur. Stage 1 seminomas treated by orchiectomy (501 cases) were analyzed to identify the risk factors for recurrence and methods of relapse detection. Rete testis invasion and, more strongly, stromal rete testis invasion increased the risk of relapse. Most recurrences were identified within 2 years of surgery by routine surveillance computed tomography scans. Stage 1 seminoma is frequently cured by radical orchiectomy; however, the management strategies after this diagnosis vary in terms of the use of adjuvant treatment and the nature of the follow-up protocols. We analyzed stage 1 seminomas treated in the Thames Valley Cancer Network for outcomes to determine whether any factors are predictive of recurrence. We also studied relapses to determine the optimal follow-up schedule and protocol. Data were obtained from centers within the Thames Valley Cancer Network for a 12-year period from 2004 to 2016. We identified 501 patients with stage 1 seminoma. Relapses occurred in 6.2% of the patients receiving adjuvant treatment and 6.1% of those who did not. The only statistically significant predictive factor identified for relapse was rete testis invasion, and the risk was greater when only stromal rete invasion was included, rather than pagetoid as well. A trend was seen toward an increased risk with increased tumor size, but the difference was not statistically significant. Recurrences developed within the first 2 years after surgery in nearly 75% of cases and were identified through surveillance computed tomography scans in 54.8% of the patients. All relapses were treated curatively. Active surveillance leads to excellent outcomes for stage 1 seminoma; however, adjuvant treatment should be reserved for those with high-risk disease. Follow-up schedules should include computed tomography imaging during the first 3 years, long-term measurement of tumor markers, and mechanisms for patients to be seen promptly should symptoms of tumor recurrence occur. Stage 1 seminoma is frequently cured by radical orchiectomy; however, the management strategies after this diagnosis vary in terms of the use of adjuvant treatment and the nature of the follow-up protocols. We analyzed stage 1 seminomas treated in the Thames Valley Cancer Network for outcomes to determine whether any factors are predictive of recurrence. We also studied relapses to determine the optimal follow-up schedule and protocol.BACKGROUNDStage 1 seminoma is frequently cured by radical orchiectomy; however, the management strategies after this diagnosis vary in terms of the use of adjuvant treatment and the nature of the follow-up protocols. We analyzed stage 1 seminomas treated in the Thames Valley Cancer Network for outcomes to determine whether any factors are predictive of recurrence. We also studied relapses to determine the optimal follow-up schedule and protocol.Data were obtained from centers within the Thames Valley Cancer Network for a 12-year period from 2004 to 2016. We identified 501 patients with stage 1 seminoma.MATERIALS AND METHODSData were obtained from centers within the Thames Valley Cancer Network for a 12-year period from 2004 to 2016. We identified 501 patients with stage 1 seminoma.Relapses occurred in 6.2% of the patients receiving adjuvant treatment and 6.1% of those who did not. The only statistically significant predictive factor identified for relapse was rete testis invasion, and the risk was greater when only stromal rete invasion was included, rather than pagetoid as well. A trend was seen toward an increased risk with increased tumor size, but the difference was not statistically significant. Recurrences developed within the first 2 years after surgery in nearly 75% of cases and were identified through surveillance computed tomography scans in 54.8% of the patients. All relapses were treated curatively.RESULTSRelapses occurred in 6.2% of the patients receiving adjuvant treatment and 6.1% of those who did not. The only statistically significant predictive factor identified for relapse was rete testis invasion, and the risk was greater when only stromal rete invasion was included, rather than pagetoid as well. A trend was seen toward an increased risk with increased tumor size, but the difference was not statistically significant. Recurrences developed within the first 2 years after surgery in nearly 75% of cases and were identified through surveillance computed tomography scans in 54.8% of the patients. All relapses were treated curatively.Active surveillance leads to excellent outcomes for stage 1 seminoma; however, adjuvant treatment should be reserved for those with high-risk disease. Follow-up schedules should include computed tomography imaging during the first 3 years, long-term measurement of tumor markers, and mechanisms for patients to be seen promptly should symptoms of tumor recurrence occur.CONCLUSIONActive surveillance leads to excellent outcomes for stage 1 seminoma; however, adjuvant treatment should be reserved for those with high-risk disease. Follow-up schedules should include computed tomography imaging during the first 3 years, long-term measurement of tumor markers, and mechanisms for patients to be seen promptly should symptoms of tumor recurrence occur. |
| Author | Protheroe, Andrew S. Traill, Zoe C. Sullivan, Mark E. Tyrrell, Helen E.J. Tuthill, Mark H. Church, David N. Verrill, Clare L. Rogers, Paul B. Joseph, Johnson Redgwell, Jacqueline Pintus, Elias P. Dallas, Nicola L. |
| Author_xml | – sequence: 1 givenname: Helen E.J. surname: Tyrrell fullname: Tyrrell, Helen E.J. email: helen.tyrrell@ouh.nhs.uk organization: Department of Oncology, Churchill Hospital, Oxford, United Kingdom – sequence: 2 givenname: David N. surname: Church fullname: Church, David N. organization: Department of Oncology, Churchill Hospital, Oxford, United Kingdom – sequence: 3 givenname: Johnson surname: Joseph fullname: Joseph, Johnson organization: Department of Oncology, Churchill Hospital, Oxford, United Kingdom – sequence: 4 givenname: Zoe C. surname: Traill fullname: Traill, Zoe C. organization: Department of Radiology, Churchill Hospital, Oxford, United Kingdom – sequence: 5 givenname: Mark E. surname: Sullivan fullname: Sullivan, Mark E. organization: Department of Urology, Churchill Hospital, Oxford, United Kingdom – sequence: 6 givenname: Mark H. surname: Tuthill fullname: Tuthill, Mark H. organization: Department of Oncology, Churchill Hospital, Oxford, United Kingdom – sequence: 7 givenname: Clare L. surname: Verrill fullname: Verrill, Clare L. organization: Department of Pathology, Churchill Hospital, Oxford, United Kingdom – sequence: 8 givenname: Elias P. surname: Pintus fullname: Pintus, Elias P. organization: Department of Oncology, Royal Berkshire Hospital, Reading, United Kingdom – sequence: 9 givenname: Nicola L. surname: Dallas fullname: Dallas, Nicola L. organization: Department of Oncology, Royal Berkshire Hospital, Reading, United Kingdom – sequence: 10 givenname: Paul B. surname: Rogers fullname: Rogers, Paul B. organization: Department of Oncology, Royal Berkshire Hospital, Reading, United Kingdom – sequence: 11 givenname: Jacqueline surname: Redgwell fullname: Redgwell, Jacqueline organization: Department of Oncology, Churchill Hospital, Oxford, United Kingdom – sequence: 12 givenname: Andrew S. surname: Protheroe fullname: Protheroe, Andrew S. organization: Department of Oncology, Churchill Hospital, Oxford, United Kingdom |
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| CitedBy_id | crossref_primary_10_1016_j_urology_2021_05_101 crossref_primary_10_1136_jclinpath_2018_205328 crossref_primary_10_1016_j_clgc_2025_102365 crossref_primary_10_1016_j_euros_2022_08_014 crossref_primary_10_1097_MOU_0000000000000999 crossref_primary_10_1002_cnr2_1310 |
| Cites_doi | 10.1038/nrc3021 10.1200/JCO.2002.01.038 10.1200/JCO.2009.26.4655 10.1200/JCO.2014.56.2116 10.1056/NEJMra1407550 10.1093/annonc/mdt304 10.1093/jnci/89.19.1429 10.1093/annonc/mdw164 10.1016/j.clgc.2014.10.006 10.1007/s00345-014-1361-y |
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| Keywords | Adjuvant radiotherapy Carboplatin Adjuvant chemotherapy Testicular cancer Relapse rates |
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| References | Gilbert, Rapley, Shipley (bib1) 2011; 11 Petrelli, Coinu, Cabiddu (bib8) 2015; 13 Oliver, Mead, Rustin (bib5) 2011; 10 Nigam, Aschebrook-Kilfoy, Shikanov, Eggener (bib3) 2014; 33 Tandstad, Stahl, Dahl (bib9) 2016; 27 Travis, Curtis, Storm (bib10) 1997; 89 Kollmannsberger, Tandstad, Bedard (bib7) 2015; 33 Hanna, Einhorn (bib4) 2014; 371 Oldenburg, Fossa, Nuver (bib6) 2013; 24 Warde, Specht, Horwich (bib2) 2002; 20 Oliver (10.1016/j.clgc.2017.12.001_bib5) 2011; 10 Tandstad (10.1016/j.clgc.2017.12.001_bib9) 2016; 27 Hanna (10.1016/j.clgc.2017.12.001_bib4) 2014; 371 Oldenburg (10.1016/j.clgc.2017.12.001_bib6) 2013; 24 Kollmannsberger (10.1016/j.clgc.2017.12.001_bib7) 2015; 33 Travis (10.1016/j.clgc.2017.12.001_bib10) 1997; 89 Petrelli (10.1016/j.clgc.2017.12.001_bib8) 2015; 13 Nigam (10.1016/j.clgc.2017.12.001_bib3) 2014; 33 Warde (10.1016/j.clgc.2017.12.001_bib2) 2002; 20 Gilbert (10.1016/j.clgc.2017.12.001_bib1) 2011; 11 |
| References_xml | – volume: 20 start-page: 4448 year: 2002 end-page: 4452 ident: bib2 article-title: Prognostic factors for relapse in stage 1 seminoma managed by surveillance: a pooled analysis publication-title: J Clin Oncol – volume: 33 start-page: 623 year: 2014 end-page: 631 ident: bib3 article-title: Increasing incidence of testicular cancer in the United States and Europe between 1992 and 2009 publication-title: World J Urol – volume: 10 start-page: 957 year: 2011 end-page: 962 ident: bib5 article-title: Randomised trial of carboplatin versus radiotherapy for stage 1 seminoma: mature results on relapse and contralateral testis cancer rates in MRC TE19/EORTC 30982 study (ISRCTN27163214) publication-title: J Clin Oncol – volume: 89 start-page: 1429 year: 1997 end-page: 1439 ident: bib10 article-title: Risk of second malignant neoplasms among long-term survivors of testicular cancer publication-title: J Natl Cancer Inst – volume: 33 start-page: 51 year: 2015 end-page: 57 ident: bib7 article-title: Patterns of relapse in patients with clinical stage 1 testicular cancer managed with active surveillance publication-title: J Clin Oncol – volume: 27 start-page: 1299 year: 2016 end-page: 1304 ident: bib9 article-title: Treatment of stage 1 seminoma, with one course of adjuvant carboplatin or surveillance, risk-adapted recommendations implementing patient autonomy: a report from the Swedish and Norwegian Testicular Cancer Group (SWENOTECA) publication-title: Ann Oncol – volume: 371 start-page: 2005 year: 2014 end-page: 2016 ident: bib4 article-title: Testicular cancer—discoveries and updates publication-title: N Engl J Med – volume: 24 start-page: vi125 year: 2013 end-page: vi132 ident: bib6 article-title: Testicular seminoma and non-seminoma: ESMO clinical practice guidelines publication-title: Ann Oncol – volume: 11 start-page: 278 year: 2011 end-page: 288 ident: bib1 article-title: Testicular germ cell tumours: predisposition genes and the male germ cell niche publication-title: Nat Rev Cancer – volume: 13 start-page: 193 year: 2015 end-page: 198 ident: bib8 article-title: Surveillance of adjuvant treatment with chemotherapy or radiotherapy in stage 1 seminoma: a systematic review and meta-analysis of 13 studies publication-title: Clin Genitourin Cancer – volume: 11 start-page: 278 year: 2011 ident: 10.1016/j.clgc.2017.12.001_bib1 article-title: Testicular germ cell tumours: predisposition genes and the male germ cell niche publication-title: Nat Rev Cancer doi: 10.1038/nrc3021 – volume: 20 start-page: 4448 year: 2002 ident: 10.1016/j.clgc.2017.12.001_bib2 article-title: Prognostic factors for relapse in stage 1 seminoma managed by surveillance: a pooled analysis publication-title: J Clin Oncol doi: 10.1200/JCO.2002.01.038 – volume: 10 start-page: 957 year: 2011 ident: 10.1016/j.clgc.2017.12.001_bib5 article-title: Randomised trial of carboplatin versus radiotherapy for stage 1 seminoma: mature results on relapse and contralateral testis cancer rates in MRC TE19/EORTC 30982 study (ISRCTN27163214) publication-title: J Clin Oncol doi: 10.1200/JCO.2009.26.4655 – volume: 33 start-page: 51 year: 2015 ident: 10.1016/j.clgc.2017.12.001_bib7 article-title: Patterns of relapse in patients with clinical stage 1 testicular cancer managed with active surveillance publication-title: J Clin Oncol doi: 10.1200/JCO.2014.56.2116 – volume: 371 start-page: 2005 year: 2014 ident: 10.1016/j.clgc.2017.12.001_bib4 article-title: Testicular cancer—discoveries and updates publication-title: N Engl J Med doi: 10.1056/NEJMra1407550 – volume: 24 start-page: vi125 issue: suppl 6 year: 2013 ident: 10.1016/j.clgc.2017.12.001_bib6 article-title: Testicular seminoma and non-seminoma: ESMO clinical practice guidelines publication-title: Ann Oncol doi: 10.1093/annonc/mdt304 – volume: 89 start-page: 1429 year: 1997 ident: 10.1016/j.clgc.2017.12.001_bib10 article-title: Risk of second malignant neoplasms among long-term survivors of testicular cancer publication-title: J Natl Cancer Inst doi: 10.1093/jnci/89.19.1429 – volume: 27 start-page: 1299 year: 2016 ident: 10.1016/j.clgc.2017.12.001_bib9 article-title: Treatment of stage 1 seminoma, with one course of adjuvant carboplatin or surveillance, risk-adapted recommendations implementing patient autonomy: a report from the Swedish and Norwegian Testicular Cancer Group (SWENOTECA) publication-title: Ann Oncol doi: 10.1093/annonc/mdw164 – volume: 13 start-page: 193 year: 2015 ident: 10.1016/j.clgc.2017.12.001_bib8 article-title: Surveillance of adjuvant treatment with chemotherapy or radiotherapy in stage 1 seminoma: a systematic review and meta-analysis of 13 studies publication-title: Clin Genitourin Cancer doi: 10.1016/j.clgc.2014.10.006 – volume: 33 start-page: 623 year: 2014 ident: 10.1016/j.clgc.2017.12.001_bib3 article-title: Increasing incidence of testicular cancer in the United States and Europe between 1992 and 2009 publication-title: World J Urol doi: 10.1007/s00345-014-1361-y |
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| Snippet | Stage 1 seminomas treated by orchiectomy (501 cases) were analyzed to identify the risk factors for recurrence and methods of relapse detection. Rete testis... Stage 1 seminoma is frequently cured by radical orchiectomy; however, the management strategies after this diagnosis vary in terms of the use of adjuvant... |
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| SubjectTerms | Adjuvant chemotherapy Adjuvant radiotherapy Adult Carboplatin Chemotherapy, Adjuvant Humans Male Neoplasm Recurrence, Local - epidemiology Orchiectomy Practice Guidelines as Topic Prospective Studies Radiotherapy, Adjuvant Relapse rates Seminoma - drug therapy Survival Analysis Testicular cancer Testicular Neoplasms - drug therapy Testicular Neoplasms - surgery Tomography, X-Ray Computed Tumor Burden Watchful Waiting - methods |
| Title | Changing Practice Evaluation—Stage 1 Seminoma: Outcomes With Adjuvant Treatment Versus Surveillance: Risk Factors for Recurrence and Optimizing Follow-up Protocols—Experience From a Supraregional Center |
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