Conditional Risk of Relapse in Surveillance for Clinical Stage I Testicular Cancer

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• 作者：Madhur Nayan^a ; Michael A.S. Jewett^a ; Ali Hosni^b ; Lynn Anson-Cartwright^a ; Philippe L. Bedard^c ; Malcolm Moore^d ; Aaron R. Hansen^c ; Peter Chung^b ; Padraig Warde^b ; Joan Sweet^e ; Martin O&rsquo ; Malley^f ; Eshetu G. Atenafu^g ; Robert J. Hamilton^a ; ^{rob.hamilton@uhn.ca}
• 关键词：Germ cell tumor ; Testicular neoplasm ; Treatment outcome
• 刊名：European Urology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：71
• 期：1
• 页码：120-127
• 全文大小：2106 K
• 卷排序：71

文摘

Patients on surveillance for clinical stage I (CSI) testicular cancer are counseled regarding their baseline risk of relapse. The conditional risk of relapse (cRR), which provides prognostic information on patients who have survived for a period of time without relapse, have not been determined for CSI testicular cancer.ObjectiveTo determine cRR in CSI testicular cancer.Design, setting, and participantsWe reviewed 1239 patients with CSI testicular cancer managed with surveillance at a tertiary academic centre between 1980 and 2014.Outcome measurements and statistical analysiscRR estimates were calculated using the Kaplan-Meier method. We stratified patients according to validated risk factors for relapse. We used linear regression to determine cRR trends over time.Results and limitationsAt orchiectomy, the risk of relapse within 5 yr was 42.4%, 17.3%, 20.3%, and 12.2% among patients with high-risk nonseminomatous germ cell tumor (NSGCT), low-risk NSGCT, seminoma with tumor size ≥3 cm, and seminoma with tumor size <3 cm, respectively. However, for patients without relapse within the first 2 yr of follow-up, the corresponding risk of relapse within the next 5 yr in the groups was 0.0%, 1.0% (95% confidence interval [CI] 0.3–1.7%), 5.6% (95% CI 3.1–8.2%), and 3.9% (95% CI 1.4–6.4%). Over time, cRR decreased (p ≤ 0.021) in all models. Limitations include changes to surveillance protocols over time and few late relapses.ConclusionsAfter 2 yr, the risk of relapse on surveillance for CSI testicular cancer is very low. Consideration should be given to adapting surveillance protocols to individualized risk of relapse based on cRR as opposed to static protocols based on baseline factors. This strategy could reduce the intensity of follow-up for the majority of patients.Patient summaryOur study is the first to provide data on the future risk of relapse during surveillance for clinical stage I testicular cancer, given a patient has been without relapse for a specified period of time.