[Surveillance of stage I testicular seminoma: 20 years oncological results].
OBJECTIVE
The objective of this study was to assess the oncological results of a population of patients which undergo surveillance after diagnosis of stage I testicular seminoma (2, 5 and 8 years overall, specific and recurrence free survival). We also research recurrence risk factors.


METHODS
We have looked at the data of all patients treated in our center since 1993 for a grade I testicular seminoma. We focused on age at diagnosis, biological (tumoral markers) and pathological (tumor size, rete testis, lymphovascular, tunica albuginea or spermatic cord invasion) data. During surveillance, we noted the number, the localization and the interval until recurrence and death. We calculated 2, 5 and 8 years overall, specific and recurrence-free survival and searched recurrence risk factors.


RESULTS
Sixty-nine patients (mean age: 37) were followed during a mean time of 97 months. Sixty-three per cent of the tumours were less than 4 cm (50 lesions). Lymphovascular, rete testis, spermatic cord and tunica albuginea invasion were present in respectively 21%, 33%, 4% and 29% of the cases. LDH and HCG were above normal rate in respectively 44 and 27% of the cases. Eighteen patients (23%) relapsed at a mean time of 12 months. Recurrence-free survival was respectively 81%, 77% and 77% at 2, 5 and 8 years. Tumor size<4 cm (P = 0.002), rete testis invasion (P = 0.03) and stage ≥ pT2 (P = 0.012) were associated with recurrence in univariate analysis. Using multivariate analysis, only tumor size >4 cm was a recurrence risk factor (risk multiplied by 3). At the end of the study, 77 patients are alive (97.5%). Overall and specific survival was 97.5% at 2, 5 and 8 years.


CONCLUSIONS
We show here the interest of surveillance in case of stage 1 testicular seminoma. The overall and specific survivals are the same as after chemotherapy or radiotherapy. Furthermore, we confirm the role of tumor size to stratify recurrence risk.
Service de chirurgie urologique, nouvel hôpital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France. Electronic address: tristan.zores@chru-strasbourg.fr.
T
T
Zores
Service de chirurgie urologique, nouvel hôpital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
P
P
Mouracade
Service d'hématologie et d'oncologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, avenue Molière, 67200 Strasbourg, France.
B
B
Duclos
Service de chirurgie urologique, nouvel hôpital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
C
C
Saussine
Service de chirurgie urologique, nouvel hôpital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
H
H
Lang
Service de chirurgie urologique, nouvel hôpital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
D
D
Jacqmin
D000328:Adult; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D009367:Neoplasm Staging; D009919:Orchiectomy / Q000379:methods; D011159:Population Surveillance; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D018239:Seminoma / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D013736:Testicular Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome
Facteurs de risque; Overall survival; Recurrence risk factors; Recurrence-free survival; Specific survival; Stade I; Stage I; Surveillance; Survie globale; Survie sans évolution; Survie spécifique; Séminome testiculaire; Testicular seminoma