title: Risk factors for relapse in patients with clinical stage I testicular nonseminomatous germ cell tumors.
abstract: Prediction of oncological outcomes facilitates individualized risk-adapted management for clinical stage I testicular nonseminomatous germ cell tumors (CS I NSGCTs). We investigated risk factors for relapse following orchidectomy, with particular focus on patients with active surveillance. Patients with CS I NSGCTs treated by retroperitoneal lymph node dissection (RPLND), chemotherapy, or surveillance between January 1997 and December 2009 were identified. Demographic and post-operative records were collected. Disease-specific survival and progression-free survival (PFS) rates were estimated using Kaplan-Meier analysis. Cox regression analysis was used to confirm variables that influenced disease relapse. A median follow-up period of 82 months was achieved in 89 patients, of whom 9 (8 in surveillance and 1 in chemotherapy group) had relapses. Cumulative 5-year PFS rates were 74.1, 92.3, and 100 % for the surveillance, chemotherapy, and RPLND groups, respectively (p = 0.01). The relapse rate was significantly higher in patients presented with lymphatic/vascular invasion (LVI) than in those without LVI (26.6 vs. 6.8 %, p = 0.02). In the surveillance group, a higher relapse rate was associated with history of cryptorchidism (50 vs. 13.3 %, p = 0.02) and an age older than 13 years (33.3 vs. 5.9 %, p = 0.04). On multivariate analysis, patient age (OR 1.16; p = 0.05), history of cryptorchidism (OR 0.09; p = 0.01), and LVI (OR 12.10; p = 0.01) were significantly associated with relapse during surveillance. The disease-free period is short in the patients with surveillance. LVI, patient age, and history of cryptorchidism may be used as predictors for relapse during surveillance.
authors: Department of Urology, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Guangdong, China.
authors: Pei
authors: P
authors: Dong
authors: Zhuo-Wei
authors: ZW
authors: Liu
authors: Xiang-Dong
authors: XD
authors: Li
authors: Yong-Hong
authors: YH
authors: Li
authors: Kai
authors: K
authors: Yao
authors: Song
authors: S
authors: Wu
authors: Zi-Ke
authors: ZK
authors: Qin
authors: Hui
authors: H
authors: Han
authors: Fang-Jian
authors: FJ
authors: Zhou
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009919:Orchiectomy; D012008:Recurrence; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
references: Eur J Endocrinol. 2005 Mar;152(3):419-25
references: 15757859
references: J Clin Oncol. 1995 May;13(5):1188-94
references: 7537802
references: BJU Int. 2000 Jul;86(1):89-93
references: 10886090
references: Eur Urol. 2008 Nov;54(5):1004-15
references: 18722704
references: Endocr Relat Cancer. 2005 Sep;12(3):645-55
references: 16172197
references: Urology. 2012 Apr;79(4):892-7
references: 22305424
references: J Natl Compr Canc Netw. 2009 Jun;7(6):672-93
references: 19555582
references: Endocrinology. 2000 Feb;141(2):846-9
references: 10650968
references: APMIS. 2001 Apr;109(4):263-72
references: 11469497
references: Am J Epidemiol. 2003 Apr 1;157(7):602-5
references: 12672679
references: Endocrinology. 2008 Feb;149(2):565-73
references: 18039775
references: Actas Urol Esp. 2012 Mar;36(3):127-45
references: 22188753
references: Semin Surg Oncol. 1999 Dec;17(4):230-9
references: 10588851
references: J Clin Oncol. 2010 Jan 1;28(1):119-25
references: 19917846
references: Dev Biol. 2000 Aug 15;224(2):354-61
references: 10926772
references: J Clin Oncol. 2011 Mar 10;29(8):963-70
references: 21300926
references: J Clin Oncol. 2007 Oct 1;25(28):4370-8
references: 17906202
references: Ann Oncol. 2009 May;20 Suppl 4:89-96
references: 19454475
references: Urology. 1999 Dec;54(6):1064-7
references: 10604709
references: Urol Clin North Am. 2007 May;34(2):137-48; abstract viii
references: 17484919
references: J Urol. 2008 Oct;180(4):1348-52; discussion 1352-3
references: 18707723
references: J Clin Oncol. 1997 Apr;15(4):1680-9
references: 9193369
references: Ai Zheng. 2008 Dec;27(12):1302-6
references: 19079998
references: Cancer Causes Control. 1998 May;9(3):253-8
references: 9684705
references: J Clin Oncol. 2003 Nov 15;21(22):4092-9
references: 14559885
references: J Clin Oncol. 2008 Aug 20;26(24):3937-42
references: 18711182
references: J Clin Oncol. 2003 Apr 15;21(8):1505-12
references: 12697874
references: Cancer. 2002 Aug 1;95(3):520-30
references: 12209744
references: Eur J Cancer. 2004 Sep;40(14):2152-8
references: 15341991