TY - JOUR
T1 - Prognostic Factor Risk Groups for Clinical Stage I Seminoma
T2 - An Individual Patient Data Analysis by the European Association of Urology Testicular Cancer Guidelines Panel and Guidelines Office
AU - Boormans, Joost L
AU - Sylvester, Richard
AU - Anson-Cartwright, Lynn
AU - Glicksman, Rachel M
AU - Hamilton, Robert J
AU - Hahn, Ezra
AU - Daugaard, Gedske
AU - Lauritsen, Jakob
AU - Wagner, Thomas
AU - Avuzzi, Barbara
AU - Nicolai, Nicola
AU - Del Muro, Xavier García
AU - Aparicio, Jorge
AU - Stalder, Odile
AU - Rothermundt, Christian
AU - Fischer, Stefanie
AU - Laguna, M Pilar
N1 - Copyright © 2023. Published by Elsevier B.V.
PY - 2024
Y1 - 2024
N2 - BACKGROUND: The relapse rate in patients with clinical stage I (CSI) seminomatous germ cell tumor of the testis (SGCTT) who were undergoing surveillance after radical orchidectomy is 4-30%, depending on tumor size and rete testis invasion (RTI). However, the level of evidence supporting the use of both risk factors in clinical decision-making is low.OBJECTIVE: We aimed to identify the most important prognostic factors for relapse in CSI SGCTT patients.DESIGN, SETTING, AND PARTICIPANTS: Individual patient data for 1016 CSI SGCTT patients diagnosed between 1994 and 2019 with normal postorchidectomy serum tumor marker levels and undergoing surveillance were collected from nine institutions.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable Cox proportional hazard regression models were fit to identify the most important prognostic factors. The primary endpoint was the time to first relapse by imaging and/or markers. Relapse probabilities were estimated by the Kaplan-Meier method.RESULTS AND LIMITATIONS: After a median follow-up of 7.7 yr, 149 (14.7%) patients had relapsed. Categorical tumor size (≤2, >2-5, and >5 cm), presence of RTI, and lymphovascular invasion were used to form three risk groups: low (56.4%), intermediate (41.3%), and high (2.3%) risks with 5-yr cumulative relapse probabilities of 8%, 20%, and 44%, respectively. The model outperformed the currently used model with tumor size ≤4 versus >4 cm and presence of RTI (Harrell's C index 0.65 vs 0.61). The low- and intermediate-risk groups were validated successfully in an independent cohort of 285 patients.CONCLUSIONS: The risk of relapse after radical orchidectomy in CSI SGCTT patients under surveillance is low. We propose a new risk stratification model that outperformed the current model and identified a small subgroup with a high risk of relapse.PATIENT SUMMARY: The risk of relapse after radical orchidectomy in patients with clinical stage I seminomatous germ cell tumor of the testis is low. We propose a new risk stratification model that outperformed the current model and identified a small subgroup with a high risk of relapse.
AB - BACKGROUND: The relapse rate in patients with clinical stage I (CSI) seminomatous germ cell tumor of the testis (SGCTT) who were undergoing surveillance after radical orchidectomy is 4-30%, depending on tumor size and rete testis invasion (RTI). However, the level of evidence supporting the use of both risk factors in clinical decision-making is low.OBJECTIVE: We aimed to identify the most important prognostic factors for relapse in CSI SGCTT patients.DESIGN, SETTING, AND PARTICIPANTS: Individual patient data for 1016 CSI SGCTT patients diagnosed between 1994 and 2019 with normal postorchidectomy serum tumor marker levels and undergoing surveillance were collected from nine institutions.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable Cox proportional hazard regression models were fit to identify the most important prognostic factors. The primary endpoint was the time to first relapse by imaging and/or markers. Relapse probabilities were estimated by the Kaplan-Meier method.RESULTS AND LIMITATIONS: After a median follow-up of 7.7 yr, 149 (14.7%) patients had relapsed. Categorical tumor size (≤2, >2-5, and >5 cm), presence of RTI, and lymphovascular invasion were used to form three risk groups: low (56.4%), intermediate (41.3%), and high (2.3%) risks with 5-yr cumulative relapse probabilities of 8%, 20%, and 44%, respectively. The model outperformed the currently used model with tumor size ≤4 versus >4 cm and presence of RTI (Harrell's C index 0.65 vs 0.61). The low- and intermediate-risk groups were validated successfully in an independent cohort of 285 patients.CONCLUSIONS: The risk of relapse after radical orchidectomy in CSI SGCTT patients under surveillance is low. We propose a new risk stratification model that outperformed the current model and identified a small subgroup with a high risk of relapse.PATIENT SUMMARY: The risk of relapse after radical orchidectomy in patients with clinical stage I seminomatous germ cell tumor of the testis is low. We propose a new risk stratification model that outperformed the current model and identified a small subgroup with a high risk of relapse.
KW - Adult
KW - Europe
KW - Humans
KW - Male
KW - Middle Aged
KW - Neoplasm Recurrence, Local/epidemiology
KW - Neoplasm Staging
KW - Orchiectomy
KW - Practice Guidelines as Topic
KW - Prognosis
KW - Retrospective Studies
KW - Risk Assessment
KW - Risk Factors
KW - Seminoma/pathology
KW - Societies, Medical
KW - Testicular Neoplasms/pathology
KW - Urology/standards
KW - Young Adult
UR - http://www.scopus.com/inward/record.url?scp=85193649915&partnerID=8YFLogxK
U2 - 10.1016/j.euo.2023.10.014
DO - 10.1016/j.euo.2023.10.014
M3 - Journal article
C2 - 37951820
SN - 2588-9311
VL - 7
SP - 537
EP - 543
JO - European urology oncology
JF - European urology oncology
IS - 3
ER -