title: The Evolving Management of Patients With Clinical Stage I Seminoma.
abstract: OBJECTIVE
  To determine trends in management and factors associated with men receiving either chemotherapy or radiation therapy post orchiectomy for clinical stage I (CSI) seminoma in a contemporary setting.
  
  
  METHODS
  The National Cancer Data Base was queried for all patients with CSI seminoma from 1998 to 2012. Adjuvant treatment after orchiectomy was classified into 3 groups: surveillance, radiotherapy, and chemotherapy. Yearly trends in management are described. Subgroup analysis for the years 2010-2012 was completed using logistic regression to determine predictors of receiving treatment.
  
  
  RESULTS
  Of 80,385 patients with testicular cancer, 16,931 had CSI seminoma. There was a progressive decline in the use of post-orchiectomy treatment from 1998 to 2012. In the years 2010-2012 (n = 5816), 59.9% of patients chose surveillance compared with 25.1% receiving radiotherapy and 15.0% receiving chemotherapy. Regression modeling demonstrated that men aged 18-30 were less likely (odds ratio [OR] 0.83, 95% confidence interval [CI] 0.69-1.00, P = .048) to receive treatment than those aged 31-37. Increasing pathologic stage was associated with a greater likelihood of treatment (OR 1.77, 95% CI 1.52-2.06), whereas patients treated at academic hospitals were less likely to receive adjuvant therapy (OR 0.77, 95% CI 0.62-0.94).
  
  
  CONCLUSIONS
  Despite a trend toward increased use of post-orchiectomy surveillance for patients with CSI seminoma, a significant portion of patients are still receiving treatment. Pathologic stage and treating hospital type have the strongest association with management decisions. Improved guideline adherence may reduce the potential for adverse effects after chemotherapy or radiation therapy for CSI seminoma.
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL; Surgical Outcomes and Quality Improvement Center (SOQIC), Northwestern University Feinberg School of Medicine, Chicago, IL. Electronic address: Richard.Matulewicz@northwestern.edu.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Matulewicz
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Oberlin
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Joel
authors.initials: J
authors.lastname: Sheinfeld
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Meeks
mesh_terms: D000293:Adolescent; D000328:Adult; D003131:Combined Modality Therapy; D019468:Disease Management; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D018239:Seminoma / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D015996:Survival Rate / Q000639:trends; D013736:Testicular Neoplasms / Q000453:epidemiology / Q000473:pathology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult