Outcome of different post-orchiectomy management for stage I seminoma: Japanese multi-institutional study including 425 patients.
OBJECTIVE
To clarify the contemporary clinical outcome of stage I seminoma and to provide information on treatment options to patients.


METHODS
A retrospective analysis of 425 patients who underwent orchiectomy for stage I seminoma between 1985 and 2006 at 25 hospitals in Japan. Relapse-free survival rates were calculated using the Kaplan-Meier method and clinicopathological factors associated with relapse were examined by univariate and multivariate analyses using the Cox proportional hazards model.


RESULTS
A total of 30 out of 425 patients had relapsed. Relapse-free survival rates at 10 years were 79, 94 and 94% in the surveillance, chemotherapy and radiotherapy groups, respectively. Post-orchiectomy management and rete testis invasion were identified as independent predictive factors associated with relapse. Rete testis invasion remained to be an independent predictive factor, even if the cases with relapses in the contralateral testis were censored. Only one patient, who relapsed after adjuvant radiotherapy, died of the disease. Overall survival at 10 years was 100, 100 and 99% in the surveillance, chemotherapy and radiotherapy groups, respectively. More than half of the patients were lost to follow up within 5 years.


CONCLUSIONS
The outcome of Japanese patients with stage I seminoma is similar to previously published Western reports. Surveillance policy is becoming a popular option in Japan, although the relapse rate in patients opting for surveillance policy is higher than those opting for adjuvant chemotherapy or radiotherapy. Rete testis invasion is an independent predictive factor associated with relapse regardless of the post-orchiectomy management. Long-term follow up is mandatory for detection of late relapse.
Department of Urology, Kyoto University Graduate School of Medicine Translational Research Center, Kyoto University Hospital, Kyoto, Osaka, Japan.
Tomomi
T
Kamba
Toshiyuki
T
Kamoto
Kazutoshi
K
Okubo
Satoshi
S
Teramukai
Yoshiyuki
Y
Kakehi
Tadashi
T
Matsuda
Osamu
O
Ogawa
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009919:Orchiectomy; D011159:Population Surveillance; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018239:Seminoma / Q000473:pathology / Q000601:surgery* / Q000628:therapy*; D013736:Testicular Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult