title: Surveillance policy for Japanese patients with stage I testicular germ cell cancer in the multi-detector computed tomography era.
abstract: BACKGROUND
  The outcome of surveillance for Japanese patients with clinical stage I testicular germ cell cancer (GCC) was investigated in the multi-detector computed tomography (MDCT) era.
  
  
  METHODS
  The medical records of 92 Japanese patients with stage I GCC, who received treatment in our institution between March 1999 and February 2013, were reviewed. As six patients requested and received prophylactic chemotherapy and two patients seriously deviated from surveillance schedule, these patients were excluded from the study. Data from a total 84 patients were analyzed,
  
  
  RESULTS
  The median follow-up period following diagnosis was 5.1 years (inter-quartile range: IQR, 2.3-7.7 years). Of the 84 patients, eight (9.5 %) had a recurrence of their cancer in this observation period. Regarding histologic subtypes, the recurrence rates were five (9.3 %) of the 54 patients with seminoma and three (10 %) of the 30 patients with nonseminomatous germ cell tumor (NSGCT). All eight patients who experienced a recurrence did so within 2 years; they all underwent induction chemotherapy and remain alive at the time of writing, with no evidence of disease. Among 31 seminoma patients with a tumor more than 4 cm in size and rete testis invasion, cancer recurred in three (9.7 %) during the surveillance period. On the other hand, among the 13 patients with NSGCT and vascular invasion, three (23 %) experienced a recurrence, whereas the figure was zero for the 11 (0 %) patients without vascular invasion.
  
  
  CONCLUSIONS
  Fewer than 10 % of Japanese patients with stage I testicular GCC suffered a recurrence in the 5-year observation period of this study. The risk of occult disease, which will result in relapse, might be decreased in the MDCT era. All patients must be fully informed of the anticipated recurrence rate and the potential risks of exposure to chemotherapy agents.
authors.affiliation: Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, 135-8550, Japan. takeshi.yuasa@jfcr.or.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yuasa
authors.affiliation: Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, 135-8550, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Inoshita
authors.affiliation: Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, 135-8550, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, 135-8550, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Urakami
authors.affiliation: Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, 135-8550, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Yamamoto
authors.affiliation: Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, 135-8550, Japan.
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Fujii
authors.affiliation: Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, 135-8550, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Masuda
authors.affiliation: Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, 135-8550, Japan.
authors.forename: Iwao
authors.initials: I
authors.lastname: Fukui
authors.affiliation: Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, 135-8550, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ishikawa
authors.affiliation: Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, 135-8550, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Yonese
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D060828:Induction Chemotherapy; D007564:Japan; D008297:Male; D061330:Multidetector Computed Tomography; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D018239:Seminoma / Q000473:pathology* / Q000601:surgery; D013736:Testicular Neoplasms / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D057832:Watchful Waiting / Q000379:methods*
chemical_list: D000970:Antineoplastic Agents
keywords: Germ cell cancer; Multi-detector computed tomography; Recurrence free survival; Stage I; Surveillance; Testicular cancer