title: Surveillance for patients with clinical stage I nonseminomatous testicular germ cell tumors.
abstract: OBJECTIVE
  To assess the prognostic value of histological parameters in patients with clinical stage I nonseminomatous germ cell tumors (NSGCTs) undergoing active surveillance post-orchiectomy.
  
  
  METHODS
  Prognoses and recurrence patterns were investigated in 78 patients with CSI NSGCT who underwent orchiectomy. Immediately following orchiectomy, patients participated in active surveillance between 1999 and 2013 at Sun Yat-sen University Cancer Center, Guangzhou, China.
  
  
  RESULTS
  23.1 % of the 78 investigated patients with CSI NSGCT relapsed, within a median time of 5.6 months It was determined using multivariate analysis that lymph vascular invasion (LVI) (OR 6.521; 95 % CI 1.872-22.721; p = 0.003) and the predominant presence of yolk sac tumor (greater than 50 %) (OR 3.537; 95 % CI 1.076-11.628; p = 0.038) independently correlated with relapse-free survival (RFS). Patients were categorized accordingly into three risk groups: low risk [<50 % presence of yolk sac tumor and LVI (-); n = 41], intermediate risk [50 % or greater presence of yolk sac tumor and LVI (+); n = 29], and high risk [50 % or greater presence of yolk sac tumor and LVI (+); n = 8]. Relapse rates of the low-risk, intermediate-risk, and high-risk groups were 7.3, 31.0, and 75.0 %, respectively.
  
  
  CONCLUSIONS
  LVI and a predominant presence of yolk sac tumor are crucial risk factors for relapse of CSI NSGCT. For patients without either of these risk factors, active surveillance post-orchiectomy is a safe and effective approach for the initial management of CSI NSGCT.
authors.affiliation: Department of Urology, Sun Yat-sen University Cancer Center, No. 651, East Dongfeng Road, Guangzhou, 510060, Guangdong Province, China.
authors.forename: Xiangdong
authors.initials: X
authors.lastname: Li
authors.forename: Shengjie
authors.initials: S
authors.lastname: Guo
authors.forename: Zhiming
authors.initials: Z
authors.lastname: Wu
authors.forename: Pei
authors.initials: P
authors.lastname: Dong
authors.forename: Yonghong
authors.initials: Y
authors.lastname: Li
authors.forename: Zhiling
authors.initials: Z
authors.lastname: Zhang
authors.forename: Kai
authors.initials: K
authors.lastname: Yao
authors.forename: Hui
authors.initials: H
authors.lastname: Han
authors.forename: Zike
authors.initials: Z
authors.lastname: Qin
authors.forename: Fangjian
authors.initials: F
authors.lastname: Zhou
authors.forename: Zhuowei
authors.initials: Z
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China / Q000453:epidemiology; D018572:Disease-Free Survival; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D009919:Orchiectomy / Q000379:methods*; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013736:Testicular Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D055815:Young Adult