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.

Gang Fan,Yang Ke,Zhi-Qiang Jiang,Xiao Zhou,Ying-Ying Xiong,Wei-Qin Han,Chun Liu,Lin Zhang,Lu Yi,Xie Yu,Xiao-Shan Wang

doi:10.7314/apjcp.2015.16.8.3267

Abstract

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). 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. 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 (X2=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%, X2=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. 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.

Highlights

Testicular non-seminomatous germ cell tumors (NSGCTs) is a relatively rare cancer type in young men between ages 25 and 39 years (Fossa et al, 2011)
Patients were divided into active surveillance group and retroperitoneal lymph node dissection (RPLND) group according to different therapeutic methods after radical orchidectomy was performed
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

Summary

Introduction

Testicular non-seminomatous germ cell tumors (NSGCTs) is a relatively rare cancer type in young men between ages 25 and 39 years (Fossa et al, 2011). A suitable treatment regimen based on relative risk factors of relapse should be established for patients with NSGCTs (Albers et al, 2011). Retroperitoneal lymph node dissection (RPLND), active surveillance, and primary chemotherapy are available for CSI-NSGCTs patients; RPLND has been suggested as a gold standard method for NSGCTs because of its excellent cure rate. Some reports have indicated that 67% of low-risk NSGCTs are overtreated because of negative pathological results of retroperitoneal lymph node in 73% to 75% of patients (Roeleveld et al, 2001). A series of institutional reports and guidelines have been recommended; options for CSI-NSGCTs were often misunderstood or misapplied, with active surveillance underutilized (Nichols et al, 2013)

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