title: Minimizing treatment without compromising cure with primary surveillance for clinical stage I embryonal predominant nonseminomatous testicular cancer: a population based analysis from British Columbia.
abstract: OBJECTIVE
  We evaluated the outcome of patients with embryonal carcinoma predominant (ECP) clinical stage (CS) I nonseminomatous testicular germ cell tumors (NSGCT) treated with primary surveillance or primary retroperitoneal lymph node dissection (RPLND).
  
  
  METHODS
  This study was a retrospective evaluation of the pathology, use of chemotherapy, surgery and outcomes in all patients with CS I NSGCT who were diagnosed within the province of British Columbia between 1990 and 2000.
  
  
  RESULTS
  A total of 205 patients were identified, of whom 107 (52%) had ECP disease. Of these patients 72 (67%) underwent primary surveillance, 32 (33%) underwent primary RPLND and 3 refused treatment. Median followup was 4 years (range 1 to 10). In the primary surveillance group 24 patients (33%) had relapse and all were treated initially with chemotherapy with 6 also requiring RPLND. The remaining 48 patients (67%) in the surveillance group were cured of disease with orchiectomy alone. In the primary RPLND group 18 patients (56%) had pathological stage I disease and 14 (44%) had pathological stage II disease. In the primary RPLND group 15 patients (46%) required chemotherapy with 11 (34%) receiving adjuvant chemotherapy and 4 receiving chemotherapy for post-RPLND relapse. No deaths from ECP testicular cancer occurred in either group. The 4-year chemotherapy-free survival rate was 65% in the surveillance group vs 50% in the RPLND group (p = 0.2).
  
  
  CONCLUSIONS
  For appropriately selected patients with CS I ECP NSGCT, primary surveillance results in fewer therapeutic interventions compared to RPLND without compromising the probability of cure.
authors.affiliation: Vancouver Cancer Centre, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, British Columbia V5Z 4E6, Canada.
authors.forename: Abdulwahab J
authors.initials: AJ
authors.lastname: Al-Tourah
authors.forename: Nevin
authors.initials: N
authors.lastname: Murray
authors.forename: Chris
authors.initials: C
authors.lastname: Coppin
authors.forename: Christian
authors.initials: C
authors.lastname: Kollmannsberger
authors.forename: Ada
authors.initials: A
authors.lastname: Man
authors.forename: Kim N
authors.initials: KN
authors.lastname: Chi
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001955:British Columbia; D018236:Carcinoma, Embryonal / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000628:therapy; D009367:Neoplasm Staging; D009919:Orchiectomy; D011159:Population Surveillance; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents