Evolving patterns of care in the management of stage I non-seminomatous germ cell tumors: data from the California Cancer Registry.
OBJECTIVE
To assess the shifting population-level practice patterns across a 20-year time span in the management of stage I non-seminomatous germ cell tumors (NSGCT).


METHODS
Using the California Cancer Registry, we reviewed all patients with stage I NSGCT between 1988 and 2010. We determined their primary treatment and their overall rates across the years. Other analyzed variables included patient age, T stage, socioeconomic status, race, and year of diagnosis. Predictors of treatment were assessed using logistic regression analysis. Predictors of overall and CSS were assessed using Cox proportional hazards models.


RESULTS
Three thousand nine hundred and sixty-one patients with stage I NSGCT were identified. The most common treatment was surveillance (48 %), followed by RPLND (26 %) and chemotherapy (24 %). Rates of surveillance increased from 35 % in 1988 to 61 % in 2010; rates of RPLND decreased from 44 % in 1988 to 10 % in 2010. These were significant changes in treatment strategies (p < 0.01). Significant predictors of undergoing surveillance included diagnosis after 2006 (OR 1.52, CI 1.25-1.84) and age at diagnosis >60 years old (OR 1.63, CI 1.19-5.82). With a median follow-up of 96 months, 5-year overall survival rate was 95 %.


CONCLUSIONS
Treatment patterns in the management of stage I NSGCT have shifted in the past two decades with an increased utilization of surveillance and concurrent decrease in use of RPLND. Surveillance is now the dominant strategy, potentially reflecting changes in perception of the oncologic safety and morbidity profile of such an approach.
Department of Urology, University of California Davis, 4860 Y Street, Suite 3500, Sacramento, CA, 96817, USA. Stanley.yap@ucdmc.ucdavis.edu.|Division of Urology, Department of Surgery, VA Northern California Health Care System, 10535 Hospital Way, Mather, CA, 95655, USA. Stanley.yap@ucdmc.ucdavis.edu.|Department of Public Health Sciences, UC Davis School of Medicine, One Shields Avenue, Davis, CA, 95616, USA. Stanley.yap@ucdmc.ucdavis.edu.
Stanley A
SA
Yap
Department of Urology, University of California Davis, 4860 Y Street, Suite 3500, Sacramento, CA, 96817, USA.
Lindsay M
LM
Yuh
Department of Urology, University of California Davis, 4860 Y Street, Suite 3500, Sacramento, CA, 96817, USA.|University of California Davis Comprehensive Cancer Center, 4501 X Street, Sacramento, CA, 96817, USA.
Christopher P
CP
Evans
Department of Urology, University of California Davis, 4860 Y Street, Suite 3500, Sacramento, CA, 96817, USA.|University of California Davis Comprehensive Cancer Center, 4501 X Street, Sacramento, CA, 96817, USA.
Marc A
MA
Dall'Era
Department of Urology, University of California Davis, 4860 Y Street, Suite 3500, Sacramento, CA, 96817, USA.|University of California Davis Comprehensive Cancer Center, 4501 X Street, Sacramento, CA, 96817, USA.
Rebecca M
RM
Wagenaar
Public Health Institute, Cancer Registry of Greater California, Sacramento, CA, USA.|Department of Public Health Sciences, UC Davis School of Medicine, One Shields Avenue, Davis, CA, 95616, USA.|University of California Davis Comprehensive Cancer Center, 4501 X Street, Sacramento, CA, 96817, USA.
Rosemary
R
Cress
Division of Hematology Oncology, Department of Internal Medicine, University of California Davis, 4501 X Street, Suite 3016, Sacramento, CA, 95817, USA.|University of California Davis Comprehensive Cancer Center, 4501 X Street, Sacramento, CA, 96817, USA.
Primo N
PN
Lara
D000328:Adult; D002140:California; D015331:Cohort Studies; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012042:Registries; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000473:pathology / Q000628:therapy*; D013997:Time Factors; D055815:Young Adult
Clinical practice patterns; Non-seminomatous germ cell tumor; Survival; Testicular neoplasms