title: Surveillance for stage I nonseminoma testicular cancer: outcomes and long-term follow-up in a population-based cohort.
abstract: OBJECTIVE
  To describe treatment results in a large cohort with stage I nonseminoma germ cell cancer (NSGCC) treated in a surveillance program.
  
  
  METHODS
  From January 1, 1984, to December 31, 2007, 1,226 patients with stage I NSGCC, including high-risk patients with vascular invasion, were observed in a surveillance program.
  
  
  RESULTS
  The relapse rate after orchiectomy alone was 30.6% at 5 years. Presence of vascular invasion together with embryonal carcinoma and rete testis invasion in the testicular primary identified a group with a relapse risk of 50%. Without risk factors, the relapse risk was 12%. Eighty percent of relapses were diagnosed within the first year after orchiectomy. The median time to relapse was 5 months (range, 1 to 308 months). Early relapses were mainly detected by increase in tumor markers, and late relapses were detected by computed tomography scans. Relapses after 5 years were seen in 0.5% of the whole cohort or in 1.6% of relapsing patients. The majority of relapses (94.4%) belonged to the good prognostic group according to the International Germ Cell Cancer Collaborative Group classification. The disease-specific survival at 15 years was 99.1%.
  
  
  CONCLUSIONS
  A surveillance policy for patients with stage I NSGCC is a safe approach associated with an excellent cure rate and an overall low treatment burden despite a high relapse rate in a small group of patients. We recommend surveillance for patients with stage I NSGCC with immediate systemic treatment at relapse. Clearly defined risk factors for relapse are presented if an option of risk-adapted treatment is preferred.
authors.affiliation: Gedske Daugaard, Maria Gry Gundgaard, Mette Saksø Mortensen, Mikael Rørth, Hans von der Maase, Ib Jarle Christensen, and Jakob Lauritsen, Copenhagen University, Rigshospitalet, Copenhagen; Mads Agerbæk, Aarhus University Hospital, Aarhus; and Niels Vilstrup Holm, Odense University Hospital, Odense, Denmark. gedske.daugaard@regionh.dk.
authors.forename: Gedske
authors.initials: G
authors.lastname: Daugaard
authors.affiliation: Gedske Daugaard, Maria Gry Gundgaard, Mette Saksø Mortensen, Mikael Rørth, Hans von der Maase, Ib Jarle Christensen, and Jakob Lauritsen, Copenhagen University, Rigshospitalet, Copenhagen; Mads Agerbæk, Aarhus University Hospital, Aarhus; and Niels Vilstrup Holm, Odense University Hospital, Odense, Denmark.
authors.forename: Maria Gry
authors.initials: MG
authors.lastname: Gundgaard
authors.affiliation: Gedske Daugaard, Maria Gry Gundgaard, Mette Saksø Mortensen, Mikael Rørth, Hans von der Maase, Ib Jarle Christensen, and Jakob Lauritsen, Copenhagen University, Rigshospitalet, Copenhagen; Mads Agerbæk, Aarhus University Hospital, Aarhus; and Niels Vilstrup Holm, Odense University Hospital, Odense, Denmark.
authors.forename: Mette Saksø
authors.initials: MS
authors.lastname: Mortensen
authors.affiliation: Gedske Daugaard, Maria Gry Gundgaard, Mette Saksø Mortensen, Mikael Rørth, Hans von der Maase, Ib Jarle Christensen, and Jakob Lauritsen, Copenhagen University, Rigshospitalet, Copenhagen; Mads Agerbæk, Aarhus University Hospital, Aarhus; and Niels Vilstrup Holm, Odense University Hospital, Odense, Denmark.
authors.forename: Mads
authors.initials: M
authors.lastname: Agerbæk
authors.affiliation: Gedske Daugaard, Maria Gry Gundgaard, Mette Saksø Mortensen, Mikael Rørth, Hans von der Maase, Ib Jarle Christensen, and Jakob Lauritsen, Copenhagen University, Rigshospitalet, Copenhagen; Mads Agerbæk, Aarhus University Hospital, Aarhus; and Niels Vilstrup Holm, Odense University Hospital, Odense, Denmark.
authors.forename: Niels Vilstrup
authors.initials: NV
authors.lastname: Holm
authors.affiliation: Gedske Daugaard, Maria Gry Gundgaard, Mette Saksø Mortensen, Mikael Rørth, Hans von der Maase, Ib Jarle Christensen, and Jakob Lauritsen, Copenhagen University, Rigshospitalet, Copenhagen; Mads Agerbæk, Aarhus University Hospital, Aarhus; and Niels Vilstrup Holm, Odense University Hospital, Odense, Denmark.
authors.forename: Mikael
authors.initials: M
authors.lastname: Rørth
authors.affiliation: Gedske Daugaard, Maria Gry Gundgaard, Mette Saksø Mortensen, Mikael Rørth, Hans von der Maase, Ib Jarle Christensen, and Jakob Lauritsen, Copenhagen University, Rigshospitalet, Copenhagen; Mads Agerbæk, Aarhus University Hospital, Aarhus; and Niels Vilstrup Holm, Odense University Hospital, Odense, Denmark.
authors.forename: Hans
authors.initials: H
authors.lastname: von der Maase
authors.affiliation: Gedske Daugaard, Maria Gry Gundgaard, Mette Saksø Mortensen, Mikael Rørth, Hans von der Maase, Ib Jarle Christensen, and Jakob Lauritsen, Copenhagen University, Rigshospitalet, Copenhagen; Mads Agerbæk, Aarhus University Hospital, Aarhus; and Niels Vilstrup Holm, Odense University Hospital, Odense, Denmark.
authors.forename: Ib Jarle
authors.initials: IJ
authors.lastname: Christensen
authors.affiliation: Gedske Daugaard, Maria Gry Gundgaard, Mette Saksø Mortensen, Mikael Rørth, Hans von der Maase, Ib Jarle Christensen, and Jakob Lauritsen, Copenhagen University, Rigshospitalet, Copenhagen; Mads Agerbæk, Aarhus University Hospital, Aarhus; and Niels Vilstrup Holm, Odense University Hospital, Odense, Denmark.
authors.forename: Jakob
authors.initials: J
authors.lastname: Lauritsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D003718:Denmark; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000097:blood / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D009919:Orchiectomy / Q000009:adverse effects / Q000401:mortality; D011159:Population Surveillance; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013736:Testicular Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor