title: Observation versus adjuvant radiation or chemotherapy in the management of stage I seminoma: clinical outcomes and prognostic factors for relapse in a large US cohort.
abstract: OBJECTIVE
  The management of stage I seminoma has evolved over the past 20 years. Contemporary management options after orchiectomy include adjuvant radiation, adjuvant chemotherapy, and observation. This analysis defines the experience at Kaiser Permanente Southern California from 1990 to 2010. We examined outcomes for stage I seminoma patients and reviewed prognostic factors for recurrence in those managed with observation.
  
  
  METHODS
  This is a retrospective study of 502 stage I seminoma patients who underwent orchiectomy from 1990 to 2010. Outcomes examined were relapse-free survival (RFS), overall survival (OS), and cause-specific survival (CSS). Risk factors for recurrence evaluated were age, preoperative hCG elevation, preoperative LDH elevation, tumor size, lymphovascular invasion, rete testis invasion, epididymis invasion, and invasion through the tunica albuginea.
  
  
  RESULTS
  Among radiation patients, 5-year RFS was 97.2%, OS was 98.0%, and CSS was 99.3%. Among chemotherapy patients, 2-year RFS was 98.3% and OS and CSS were 100%. Among observation patients, 5-year RFS was 89.2%, OS was 98.8%, and CSS was 100%. There was no difference in OS or CSS among the groups. RFS was significantly lower for observation patients. Among observation patients, univariate analysis identified tumor size, lymphovascular invasion, and rete testis invasion as risk factors for relapse. No factors were significant on multivariate analysis.
  
  
  CONCLUSIONS
  Our data show that adjuvant radiation and chemotherapy yield similar outcomes in the management of stage I seminoma. Observation results in a lower RFS, but patients who relapse can be salvaged; OS and CSS are not affected.
authors.affiliation: *Department of Radiation Oncology, Kaiser Permanente Los Angeles Medical Center, Los Angeles †Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA.
authors.forename: Margaret S
authors.initials: MS
authors.lastname: Soper
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Hastings
authors.forename: Harry A
authors.initials: HA
authors.lastname: Cosmatos
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Slezak
authors.forename: Ricardo
authors.initials: R
authors.lastname: Wang
authors.forename: Kenneth
authors.initials: K
authors.lastname: Lodin
mesh_terms: D000328:Adult; D002140:California; D017024:Chemotherapy, Adjuvant; D006063:Chorionic Gonadotropin / Q000097:blood; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D009919:Orchiectomy; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018239:Seminoma / Q000473:pathology; D013736:Testicular Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D006063:Chorionic Gonadotropin