title: A nationwide cohort study of stage I seminoma patients followed on a surveillance program.
abstract: BACKGROUND
  Increasing concerns about late effects after adjuvant treatment for stage I seminoma have made surveillance an attractive alternative.
  
  
  OBJECTIVE
  To evaluate the surveillance strategy in a nationwide cohort study.
  
  
  METHODS
  A retrospective, population-based study of Danish patients diagnosed with stage I seminoma between 1984 and 2008 and followed for 5 yr (n=1954). Patient data were linked with national registries on November 30, 2012, to obtain information on late relapse, vital status, and cause of death.
  
  
  METHODS
  Disease-specific survival (DSS), overall survival, relapse rates, time to relapse, detection of relapse, and prognostic factors for relapse were described for the cohort. The Kaplan-Meier method was used to determine survival probabilities. A Cox proportional hazards model was used for multivariate analysis of prognostic factors.
  
  
  CONCLUSIONS
  Median follow-up time was 15.1 yr. In total, 369 patients relapsed after a median 13.7 mo. DSS after 15 yr was 99.3%. Tumor size was a significant factor for relapse. Either vascular invasion or invasion of epididymis was significant if the other factor was excluded from analysis. Limitations include the retrospective nature of the study and the number of missing values in analysis.
  
  
  CONCLUSIONS
  In the world's largest study of stage I seminoma patients, we found surveillance to be a safe alternative to adjuvant therapies. Tumor size was a significant factor for relapse, together with either invasion of epididymis or vascular invasion.
  
  
  RESULTS
  In this nationwide study, we looked at the outcomes of patients with stage I seminoma followed for 5 yr. We found that surveillance is a safe alternative to adjuvant treatment.
authors: Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark. Electronic address: mette.saksoe.mortensen@regionh.dk.
authors: Mette Saksø
authors: MS
authors: Mortensen
authors: Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark.
authors: Jakob
authors: J
authors: Lauritsen
authors: Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark; Danish Cancer Society, Copenhagen, Denmark.
authors: Maria Gry
authors: MG
authors: Gundgaard
authors: Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
authors: Mads
authors: M
authors: Agerbæk
authors: Department of Oncology, Odense University Hospital, Odense, Denmark.
authors: Niels Vilstrup
authors: NV
authors: Holm
authors: Finsen Laboratory, Rigshospitalet, and Biotech Research and Innovation Centre, University of Copenhagen, Copenhagen Biocenter, Copenhagen, Denmark.
authors: Ib Jarle
authors: IJ
authors: Christensen
authors: Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark.
authors: Hans
authors: H
authors: von der Maase
authors: Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark.
authors: Gedske
authors: G
authors: Daugaard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001808:Blood Vessels / Q000473:pathology; D003718:Denmark; D018572:Disease-Free Survival; D004822:Epididymis / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D009367:Neoplasm Staging; D009919:Orchiectomy; D012189:Retrospective Studies; D018239:Seminoma / Q000473:pathology* / Q000628:therapy*; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000473:pathology* / Q000628:therapy*; D047368:Tumor Burden; D057832:Watchful Waiting; D055815:Young Adult
keywords: Germ cell cancer; Stage I seminoma; Surveillance