title: Prognostic factors for relapse in stage I seminoma: a new nomogram derived from three consecutive, risk-adapted studies from the Spanish Germ Cell Cancer Group (SGCCG).
abstract: BACKGROUND
  We aimed to analyze prognostic factors for relapse in stage I seminoma managed by either active surveillance or adjuvant chemotherapy, and to describe the long-term patterns of recurrence in both groups.
  
  
  METHODS
  From 1994 to 2008, 744 patients were included in three consecutive, prospective risk-adapted studies by the Spanish Germ Cell Cancer Group. Low-risk patients were managed by surveillance and high-risk patients were given two courses of adjuvant carboplatin. Relapses were treated mainly with chemotherapy. Patient age, tumor size, histological variant, pT staging, rete testis invasion, and preoperative serum BHCG levels were assessed for prediction of disease-free survival (DFS).
  
  
  RESULTS
  After a median follow-up of 80 months, 63 patients (11.1%) have relapsed: 51/396 (14.8%) on surveillance and 12/348 (3.2%) following adjuvant carboplatin. Actuarial overall 5-year DFS was 92.3% (88.3% for surveillance versus 96.8% for chemotherapy, P = 0.0001). Median time to relapse was 14 months. Most recurrences were located at retroperitoneum (86%), with a median tumor size of 26 mm. All patients were rendered disease-free with chemotherapy (92%), radiotherapy (5%), or surgery followed by chemotherapy (3%). A nomogram was developed from surveillance patients that includes two independent, predictive factors for relapse: rete testis invasion and tumor size (as a continuous variable).
  
  
  CONCLUSIONS
  Long-term follow-up confirms the risk-adapted approach as an effective option for patients with stage I seminoma. The pattern of relapses after adjuvant chemotherapy is similar to that observed following surveillance. A new nomogram for prediction of DFS among patients on surveillance is proposed. Rete testis invasion and tumor size should be taken into account when considering the administration of adjuvant carboplatin. Prospective validation is warranted.
authors.affiliation: Department of Medical Oncology, Hospital Universitario y Politécnico La Fe, Valencia. Electronic address: japariciou@seom.org.
authors.forename: J
authors.initials: J
authors.lastname: Aparicio
authors.affiliation: Department of Medical Oncology, Hospital de Sant Pau, Barcelona.
authors.forename: P
authors.initials: P
authors.lastname: Maroto
authors.affiliation: Department of Medical Oncology, Institut Català d'Oncologia, L'Hospitalet.
authors.forename: X
authors.initials: X
authors.lastname: García Del Muro
authors.affiliation: Department of Medical Oncology, Hospital Clínico Virgen de la Victoria, Málaga.
authors.forename: A
authors.initials: A
authors.lastname: Sánchez-Muñoz
authors.affiliation: Department of Medical Oncology, Hospital Universitari Sant Joan, Reus.
authors.forename: J
authors.initials: J
authors.lastname: Gumà
authors.affiliation: Department of Medical Oncology, Hospital Germans Trias i Pujol, Badalona.
authors.forename: M
authors.initials: M
authors.lastname: Margelí
authors.affiliation: Department of Medical Oncology, Hospital Clínico, Zaragoza.
authors.forename: A
authors.initials: A
authors.lastname: Sáenz
authors.affiliation: Department of Medical Oncology, Hospital Donostia, San Sebastián.
authors.forename: N
authors.initials: N
authors.lastname: Sagastibelza
authors.affiliation: Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid.
authors.forename: D
authors.initials: D
authors.lastname: Castellano
authors.affiliation: Department of Medical Oncology, Hospital Universitario Gregorio Marañón, Madrid.
authors.forename: J A
authors.initials: JA
authors.lastname: Arranz
authors.affiliation: Biostatistics Unit, Instituto de Investigación Sanitaria La Fe, Valencia.
authors.forename: D
authors.initials: D
authors.lastname: Hervás
authors.affiliation: Department of Medical Oncology, Hospital Mutua de Terrassa, Barcelona.
authors.forename: R
authors.initials: R
authors.lastname: Bastús
authors.affiliation: Department of Medical Oncology, Complejo Hospitalario de Albacete, Albacete.
authors.forename: A
authors.initials: A
authors.lastname: Fernández-Aramburo
authors.affiliation: Department of Medical Oncology, Hospital Clínico San Carlos, Madrid.
authors.forename: J
authors.initials: J
authors.lastname: Sastre
authors.affiliation: Department of Medical Oncology, Hospital Son Espases, Palma de Mallorca.
authors.forename: J
authors.initials: J
authors.lastname: Terrasa
authors.affiliation: Department of Medical Oncology, Hospital Universitario Marqués de Valdecilla, Santander.
authors.forename: M
authors.initials: M
authors.lastname: López-Brea
authors.affiliation: Department of Medical Oncology, Institut Català d'Oncologia, Girona.
authors.forename: J
authors.initials: J
authors.lastname: Dorca
authors.affiliation: Department of Medical Oncology, Hospital Universitario Doctor Peset, Valencia.
authors.forename: D
authors.initials: D
authors.lastname: Almenar
authors.affiliation: Department of Medical Oncology, Hospital Universitario Vall d'Hebrón, Barcelona.
authors.forename: J
authors.initials: J
authors.lastname: Carles
authors.affiliation: Department of Medical Oncology, Instituto Oncológico Guipúzcoa, San Sebastián, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Hernández
authors.affiliation: Department of Medical Oncology, Institut Català d'Oncologia, L'Hospitalet.
authors.forename: J R
authors.initials: JR
authors.lastname: Germà
mesh_terms: D000293:Adolescent; D000328:Adult; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D049451:Nomograms; D009919:Orchiectomy; D011379:Prognosis; D012307:Risk Factors; D018239:Seminoma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery
keywords: adjuvant carboplatin; prognostic factors; seminoma; stage I; surveillance