title: Non-risk-adapted surveillance in clinical stage I nonseminomatous germ cell tumors: the Princess Margaret Hospital's experience.
abstract: BACKGROUND
  Since 1981 Princess Margaret Hospital has used initial active surveillance (AS) with delayed treatment at relapse as the preferred management for all patients with clinical stage I nonseminomatous germ cell tumors (NSGCT).
  
  
  OBJECTIVE
  Our aim was to report our overall AS experience and compare outcomes over different periods using this non-risk-adapted approach.
  
  
  METHODS
  Three hundred and seventy-one patients with stage I NSGCT were managed by AS from 1981 to 2005. For analysis by time period, patients were divided into two cohorts by diagnosis date: initial cohort, 1981-1992 (n=157), and recent cohort, 1993-2005 (n=214).
  
  
  METHODS
  Patients were followed at regular intervals, and treatment was only given for relapse.
  
  
  METHODS
  Recurrence rates, time to relapse, risk factors for recurrence, disease-specific survival, and overall survival were determined.
  
  
  CONCLUSIONS
  With a median follow-up of 6.3 yr, 104 patients (28%) relapsed: 53 of 157 (33.8%) in the initial group and 51 of 214 (23.8%) in the recent group. Median time to relapse was 7 mo. Lymphovascular invasion (p<0.0001) and pure embryonal carcinoma (p=0.02) were independent predictors of recurrence; 125 patients (33.7%) were designated as high risk based on the presence of one or both factors. In the initial cohort, 66 of 157 patients (42.0%) were high risk and 36 of 66 patients (54.5%) relapsed versus 17 of 91 low-risk patients (18.7%) (p<0.0001). In the recent cohort, 59 of 214 patients (27.6%) were high risk and 29 of 59 had a recurrence (49.2%) versus 22 of 155 low-risk patients (14.2%) (p<0.0001). Three patients (0.8%) died from testis cancer. The estimated 5-yr disease-specific survival was 99.3% in the initial group and 98.9% in the recent one.
  
  
  CONCLUSIONS
  Non-risk-adapted surveillance is an effective, simple strategy for the management of all stage I NSGCT.
authors.affiliation: Department of Medical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Jeremy F
authors.initials: JF
authors.lastname: Sturgeon
authors.forename: Malcolm J
authors.initials: MJ
authors.lastname: Moore
authors.forename: David M
authors.initials: DM
authors.lastname: Kakiashvili
authors.forename: Ignacio
authors.initials: I
authors.lastname: Duran
authors.forename: Lynn C
authors.initials: LC
authors.lastname: Anson-Cartwright
authors.forename: Dominik R
authors.initials: DR
authors.lastname: Berthold
authors.forename: Padraig R
authors.initials: PR
authors.lastname: Warde
authors.forename: Mary K
authors.initials: MK
authors.lastname: Gospodarowicz
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Alison
authors.forename: Justin
authors.initials: J
authors.lastname: Liu
authors.forename: Clement
authors.initials: C
authors.lastname: Ma
authors.forename: Greg R
authors.initials: GR
authors.lastname: Pond
authors.forename: Michael A
authors.initials: MA
authors.lastname: Jewett
mesh_terms: D000328:Adult; D015331:Cohort Studies; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009864:Ontario / Q000453:epidemiology; D009919:Orchiectomy; D011159:Population Surveillance; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D013997:Time Factors; D055815:Young Adult