Non-risk-adapted surveillance in clinical stage I nonseminomatous germ cell tumors: the Princess Margaret Hospital's experience.

Détails

ID Serval
serval:BIB_89388913C316
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Non-risk-adapted surveillance in clinical stage I nonseminomatous germ cell tumors: the Princess Margaret Hospital's experience.
Périodique
European urology
Auteur(s)
Sturgeon J.F., Moore M.J., Kakiashvili D.M., Duran I., Anson-Cartwright L.C., Berthold D.R., Warde P.R., Gospodarowicz M.K., Alison R.E., Liu J., Ma C., Pond G.R., Jewett M.A.
ISSN
1873-7560 (Electronic)
ISSN-L
0302-2838
Statut éditorial
Publié
Date de publication
04/2011
Peer-reviewed
Oui
Volume
59
Numéro
4
Pages
556-562
Langue
anglais
Notes
Publication types: JOURNAL ARTICLE
Publication types: Journal Article
Publication Status: ppublish
Résumé
Since 1981 Princess Margaret Hospital has used initial active surveillance (AS) with delayed treatment at relapse as the preferred management for all patients with clinical stage I nonseminomatous germ cell tumors (NSGCT).
Our aim was to report our overall AS experience and compare outcomes over different periods using this non-risk-adapted approach.
Three hundred and seventy-one patients with stage I NSGCT were managed by AS from 1981 to 2005. For analysis by time period, patients were divided into two cohorts by diagnosis date: initial cohort, 1981-1992 (n=157), and recent cohort, 1993-2005 (n=214).
Patients were followed at regular intervals, and treatment was only given for relapse.
Recurrence rates, time to relapse, risk factors for recurrence, disease-specific survival, and overall survival were determined.
With a median follow-up of 6.3 yr, 104 patients (28%) relapsed: 53 of 157 (33.8%) in the initial group and 51 of 214 (23.8%) in the recent group. Median time to relapse was 7 mo. Lymphovascular invasion (p<0.0001) and pure embryonal carcinoma (p=0.02) were independent predictors of recurrence; 125 patients (33.7%) were designated as high risk based on the presence of one or both factors. In the initial cohort, 66 of 157 patients (42.0%) were high risk and 36 of 66 patients (54.5%) relapsed versus 17 of 91 low-risk patients (18.7%) (p<0.0001). In the recent cohort, 59 of 214 patients (27.6%) were high risk and 29 of 59 had a recurrence (49.2%) versus 22 of 155 low-risk patients (14.2%) (p<0.0001). Three patients (0.8%) died from testis cancer. The estimated 5-yr disease-specific survival was 99.3% in the initial group and 98.9% in the recent one.
Non-risk-adapted surveillance is an effective, simple strategy for the management of all stage I NSGCT.

Mots-clé
Adult, Cohort Studies, Disease-Free Survival, Follow-Up Studies, Humans, Male, Neoplasm Recurrence, Local/mortality, Neoplasm Staging, Neoplasms, Germ Cell and Embryonal/mortality, Neoplasms, Germ Cell and Embryonal/pathology, Neoplasms, Germ Cell and Embryonal/surgery, Ontario/epidemiology, Orchiectomy, Population Surveillance, Prognosis, Risk Factors, Survival Analysis, Testicular Neoplasms/mortality, Testicular Neoplasms/pathology, Testicular Neoplasms/surgery, Time Factors, Young Adult
Pubmed
Création de la notice
18/02/2011 15:04
Dernière modification de la notice
20/08/2019 14:48
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