Comparative Effectiveness of Risk-adapted Surveillance vs Retroperitoneal Lymph Node Dissection in Clinical Stage I Nonseminomatous Germ Cell Testicular Cancer: A Retrospective Follow-up Study of 81 Patients.
OBJECTIVE
To retrospective assess the potential predictors for relapse and create an effective clinical mode for surveillance after orchidectomy in clinical stage I non-seminomatous germ cell testicular tumors (CSI-NSGCTs).


METHODS
We analyzed data for CSI-NSGCTs patients with non-lymphatic vascular invasion, %ECa < 50% (percentage of embryonal carcinoma < 50%), and negative or declining tumor markers to their half-life following orchidectomy (defined as low-risk patients); these patients were recruited from four Chinese centers between January 1999 and October 2013. Patients were divided into active surveillance group and retroperitoneal lymph node dissection (RPLND) group according to different therapeutic methods after radical orchidectomy was performed. The disease-free survival rates (DFSR) and overall survival rates (OSR) of the two groups were compared by Kaplan-Meier analysis.


RESULTS
A total of 121 patients with CSI-NSGCT were collected from four centers, and 81 low-risk patients, including 54 with active surveillance and 27 with RPLND, were enrolled at last. The median follow-up duration was 66.2 (range 6-164) months in the RPLND group and 65.9 (range 8-179) months in the surveillance group. OSR was 100% in active surveillance and RPLND groups, and DFSR was 89.8% and 87.0%, respectively. No significant difference was observed between these two groups (X2=0.108, P=0.743). No significant difference was observed between the patients with a low percentage of embryonal carcinoma (<50%) and those without embryonal carcinoma (87.0% and 91.9%, X2=0.154, P=0.645). No treatment-related complications were observed in the active surveillance group whereas minor and major complications were observed in 13.0% and 26.1% of the RPLND group, respectively.


CONCLUSIONS
Active surveillance resulted in similar DFSR and OSR compared with RPLND in our trial. Patients with low-risk CSI-NSGCTs could benefit from risk-adapted surveillance after these patients were subjected to radical orchidectomy.
Department of Urology, Hunan Provincial Tumor Hospital, The Affiliated Cancer Hospital of Xiangya Medical College, Central South University, Changsha, Hunan, China E-mail : 1715840770@qq.com.
Gang
G
Fan
Lin
L
Zhang
Lu
L
Yi
Zhi-Qiang
ZQ
Jiang
Yang
Y
Ke
Xiao-Shan
XS
Wang
Ying-Ying
YY
Xiong
Wei-Qin
WQ
Han
Xiao
X
Zhou
Chun
C
Liu
Xie
X
Yu
D000293:Adolescent; D000328:Adult; D018236:Carcinoma, Embryonal / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018572:Disease-Free Survival; D018240:Endodermal Sinus Tumor / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology / Q000601:surgery; D009919:Orchiectomy; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D012306:Risk; D013724:Teratoma / Q000473:pathology / Q000601:surgery*; D013736:Testicular Neoplasms / Q000473:pathology / Q000601:surgery*; D057832:Watchful Waiting / Q000379:methods*; D055815:Young Adult