title: Prognostic factors for relapse in stage I testicular seminoma treated with surveillance.
abstract: OBJECTIVE
  We sought to identify prognostic factors predictive of disease progression in patients with clinical stage I seminoma on surveillance following orchiectomy.
  
  
  METHODS
  Between January 1981 and December 1993, 201 patients 20 to 86 years old (median age 34) with clinical stage I seminoma were placed on surveillance following orchiectomy. The potential prognostic factors studied included age, tumor size, mitotic count, S phase fraction, ploidy, presence of small vessel invasion, syncytiotrophoblasts and tumor infiltrating lymphocytes, expression of beta-human chorionic gonadotropin and low molecular weight keratin on immunohistochemistry.
  
  
  RESULTS
  With a median followup of 6.1 years (range 1.3 to 12.3) 31 patients had relapse for an actuarial 5-year relapse-free rate of 84.9%. The 5-year actuarial survival rate was 97.1% and the cause specific survival rate was 99.5%. On univariate analysis factors predictive of relapse were tumor size (5-year relapse-free rate 88 and 67% for tumors 6 cm. or less and greater than 6 cm., respectively, p = 0.004), age (5-year relapse-free rate 79 and 91% for age 34 years or younger versus older than 34 years, respectively, p = 0.009) and presence of small vessel invasion (5-year relapse-free rate 86 versus 69%, p = 0.01). On multivariate analysis age and tumor size were predictive of relapse, while small vessel invasion approached statistical significance. The risk of relapse in 57 patients with none of the 3 adverse prognostic factors (age greater than 34 years, tumor 6 cm. or smaller and no small vessel invasion) was 6%.
  
  
  CONCLUSIONS
  We identified age, size of the primary tumor and small vessel invasion as important prognostic factors for relapse in patients with stage I seminoma treated with surveillance. Further followup and assessment of biological factors are needed to optimize selection of patients at a high risk for relapse who should receive immediate postoperative therapy.
authors.affiliation: Department of Radiation Oncology, University of Toronto and Toronto Hospital, Ontario, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Warde
authors.forename: M K
authors.initials: MK
authors.lastname: Gospodarowicz
authors.forename: D
authors.initials: D
authors.lastname: Banerjee
authors.forename: T
authors.initials: T
authors.lastname: Panzarella
authors.forename: L
authors.initials: L
authors.lastname: Sugar
authors.forename: C N
authors.initials: CN
authors.lastname: Catton
authors.forename: J F
authors.initials: JF
authors.lastname: Sturgeon
authors.forename: M
authors.initials: M
authors.lastname: Moore
authors.forename: M A
authors.initials: MA
authors.lastname: Jewett
mesh_terms: D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D009919:Orchiectomy; D011379:Prognosis; D018239:Seminoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D013736:Testicular Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*