Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

Comparative Effectiveness of Risk-adapted Surveillance vs Retroperitoneal Lymph Node Dissection in Clinical Stage I Nonseminomatous Germ Cell Testicular Cancer: A Retrospective Follow-up Study of 81 Patients

  • Fan, Gang (Department of Urology, Hunan Provincial Tumor Hospital, The Affiliated Cancer Hospital of Xiangya Medical College, Central South University) ;
  • Zhang, Lin (Department of Social Medicine and Health Management, Public Health School, Department of Urology, Central South University) ;
  • Yi, Lu (The Second Xiangya Hospital, Central South University) ;
  • Jiang, Zhi-Qiang (The Third Xiangya Hospital, Central South University) ;
  • Ke, Yang (Hunan Provincial People's Hospital, Central South University) ;
  • Wang, Xiao-Shan (Department of Social Medicine and Health Management, Public Health School, Department of Urology, Central South University) ;
  • Xiong, Ying-Ying (Department of pathology, Hunan Provincial Tumor Hospital, The Affiliated Cancer Hospital of Xiangya Medical College, Central South University) ;
  • Han, Wei-Qin (Department of Urology, Hunan Provincial Tumor Hospital, The Affiliated Cancer Hospital of Xiangya Medical College, Central South University) ;
  • Zhou, Xiao (Department of Urology, Hunan Provincial Tumor Hospital, The Affiliated Cancer Hospital of Xiangya Medical College, Central South University) ;
  • Liu, Chun (Department of Urology, Hunan Provincial Tumor Hospital, The Affiliated Cancer Hospital of Xiangya Medical College, Central South University) ;
  • Yu, Xie (Department of Urology, Hunan Provincial Tumor Hospital, The Affiliated Cancer Hospital of Xiangya Medical College, Central South University)
  • Published : 2015.04.29
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: To retrospective assess the potential predictors for relapse and create an effective clinical mode for surveillance after orchidectomy in clinical stage I non-seminomatous germ cell testicular tumors (CSI-NSGCTs). Materials and Methods: We analyzed data for CSI-NSGCTs patients with non-lymphatic vascular invasion, %ECa < 50% (percentage of embryonal carcinoma < 50%), and negative or declining tumor markers to their half-life following orchidectomy (defined as low-risk patients); these patients were recruited from four Chinese centers between January 1999 and October 2013. Patients were divided into active surveillance group and retroperitoneal lymph node dissection (RPLND) group according to different therapeutic methods after radical orchidectomy was performed. The disease-free survival rates (DFSR) and overall survival rates (OSR) of the two groups were compared by Kaplan-Meier analysis. Results: A total of 121 patients with CSI-NSGCT were collected from four centers, and 81 low-risk patients, including 54 with active surveillance and 27 with RPLND, were enrolled at last. The median follow-up duration was 66.2 (range 6-164) months in the RPLND group and 65.9 (range 8-179) months in the surveillance group. OSR was 100% in active surveillance and RPLND groups, and DFSR was 89.8% and 87.0%, respectively. No significant difference was observed between these two groups ($X_2=0.108$, P=0.743). No significant difference was observed between the patients with a low percentage of embryonal carcinoma (<50%) and those without embryonal carcinoma (87.0% and 91.9%, $X_2=0.154$, P=0.645). No treatment-related complications were observed in the active surveillance group whereas minor and major complications were observed in 13.0% and 26.1% of the RPLND group, respectively. Conclusions: Active surveillance resulted in similar DFSR and OSR compared with RPLND in our trial. Patients with low-risk CSI-NSGCTs could benefit from risk-adapted surveillance after these patients were subjected to radical orchidectomy.

Keywords

References

  1. Albers P, Albrecht W, Algaba F, et al (2011). EAU guidelines on testicular cancer: 2011 update. Eur Urol, 60, 304-19. https://doi.org/10.1016/j.eururo.2011.05.038
  2. Arai Y, Kawakita M, Hida S, et al (1996). Psychosocial aspects in long-term survivors of testicular cancer. J Urol, 155, 574-8. https://doi.org/10.1016/S0022-5347(01)66452-8
  3. Albqami N, Janetschek G (2005). Laparoscopic retroperitoneal lymph-node dissection in the management of clinical stage I and II testicular cancer. J Endourol, 19, 683-92. https://doi.org/10.1089/end.2005.19.683
  4. Bridges PJ., Sgarifi R, Razzaq A, Guinan P (1998). Decreased survival of black Americans with testicular cancer. J Urol, 159, 1221-3. https://doi.org/10.1016/S0022-5347(01)63563-8
  5. Duran I, Sturgeon JF, Jewett MA, et al (2007). Initial versus recent outcomes with a non-risk adapted surveillance policy in stage I non-seminomatous germ cell tumors (NSGCT). J Clin Oncol, 25, 5021.
  6. Divrik RT, Akdogan B, Ozen H, Zorlu F (2006). Outcomes of surveillance protocol of clinical stage I nonseminomatous germ cell tumors-is shift to risk adapted policy justified? J Urol, 176, 1424-30. https://doi.org/10.1016/j.juro.2006.06.012
  7. Fossa SD, Cvancarova M, Chen L, Allan AL, et al (2011). Adverse prognostic factors for testicular cancer-specific survival: a population-based study of 27,948 patients. J Clin Oncol, 29, 963-70. https://doi.org/10.1200/JCO.2010.32.3204
  8. Giwercman A, Lundin KB, Eberhard J, et al (2004). Linkage between androgen receptor gene CAG trinucleotide repeat length and testicular germ cell cancer histological type and clinical stage. Eur J Cancer, 40, 2152-8. https://doi.org/10.1016/j.ejca.2004.06.004
  9. Hao J, Zhao P, Chen WQ (2012). Chinese cancer registry annual report [M]. National cancer center, 118-9.
  10. Heidenreich A, Pfister D (2012). Management of patients with clinical stage I nonseminomatous testicular germ cell tumours: active surveillance versus primary chemotherapy versus nerve sparing retroperitoneal lymphadenectomy. Arch Esp Urol, 65, 215.
  11. Jaffe DH, Manor O, Eisenbach Z, Neumark YD (2007). The protective effect of marriage on mortality in a dynamic society. Ann Epodemiol, 17, 540-7. https://doi.org/10.1016/j.annepidem.2006.12.006
  12. Kollmannsberger C, Moore C, Chi KN, et al (2010). Nonrisk-adapted surveillance for patients with stage I nonseminomatous testicular germ-cell tumors: diminishing treatment-related morbidity while maintaining efficacy. Ann Oncol, 21, 1296-301. https://doi.org/10.1093/annonc/mdp473
  13. Maule M, Malavassi JL, Richiardi L (2012). Age at puberty and risk of testicular cancer: a meta-analysis. Int J Androl, 35, 828-34. https://doi.org/10.1111/j.1365-2605.2012.01286.x
  14. Nichols CR, Roth B, Albers P, et al (2013). Active surveillance is the preferred approach to clinical stage I testicular cancer. J Clin Oncol, 31, 3490-93. https://doi.org/10.1200/JCO.2012.47.6010
  15. Roeleveld TA, Horenblas S, Meinhardt WIM, et al (2001). Surveillance can be the standard of care for stage I nonseminomatous testicular tumors and even high risk patients. J Urol, 166, 2166-70. https://doi.org/10.1016/S0022-5347(05)65527-9
  16. Sobin LH, Gospodarowicz MK, Wittekind C (Eds.). (2011). TNM classification of malignant tumours. John Wiley & Sons.
  17. Tong S, Chen M, Zu X, et al (2014). Trans-and extraperitoneal retroperitoneal lymph node dissection (RPLND) in the treatment for nonseminomatous germ cell testicular tumors (NSGCT): a single Chinese center's retrospective analysis. Int Urol Nephrol, 46, 363-9. https://doi.org/10.1007/s11255-013-0547-3
  18. Vidal AD, Thalmann GN, Karamitopoulou-Diamantis E, et al (2014). Long term outcome of patients with clinical stage I high-risk nonseminomatous germ cell tumors 15 years after one adjuvant cycle of bleomycin, etoposide and cisplatin chemotherapy. Ann Oncol, 26, 374-7.
  19. Wood L, Kollmannsberger C, Jewett M, et al (2010). Canadian consensus guidelines for the management of testicular germ cell cancer. Can Urol Assoc J, 4, 19-38.