Contemporary Assessment of Long-Term Survival Rates in Patients With Stage I Nonseminoma Germ-Cell Tumor of the Testis: Population-Based Comparison Between Surveillance and Active Treatment After Initial Orchiectomy.

Abstract

BACKGROUND:

Historical data demonstrated similar survival outcomes in patients with stage I nonseminoma germ-cell tumor of the testis (NSGCTT) subjected to either surveillance or active treatment (AT) after orchiectomy. However, data with long-term follow-up are unavailable. We tested contemporary treatment rates and their effect on cancer-specific mortality (CSM) and other-cause mortality (OCM) relative to surveillance, as well as after stratification between chemotherapy (CHT) versus retroperitoneal lymph node dissection (RPLND).

PATIENTS AND METHODS:

We identified patients with stage I NSGCTT with initial orchiectomy within the Surveillance, Epidemiology, and End Results (SEER) database (1988-2015). Subsequent surveillance versus CHT versus RPLND use rates were reported. Cumulative incidence plots and multivariable competing-risks regression (CRR) models were used after propensity score (PS) matching. These tests first compared surveillance versus AT (CHT vs. RPLND) and subsequently CHT versus RPLND.

RESULTS:

Of 5034 patients with stage I NSGCTT, 61.2%, 24.9%, and 13.9%, respectively, underwent surveillance, CHT, and RPLND. Between 1988 and 2015, surveillance (estimated annual percentage change [EAPC]: +1.1%, P < .001) and CHT (EAPC: +2.3%, P < .001) rates increased. RPLND rates decreased (EAPC: -5.7%; P < .001). After PS matching, CRR models failed to identify AT as an independent predictor of lower mortality relative to surveillance. However, after PS matching, CRR models identified RPLND as an independent predictor of lower CSM (hazard ratio, 0.26; P = .002) relative to CHT. No difference in OCM rates was recorded (hazard ratio, 1.25; P = .2).

CONCLUSION:

Surveillance and CHT use rates increased while RPLND decreased in the last two decades. Virtually the same outcomes were recorded between surveillance and AT. However, within AT, RPLND was associated with lower CSM than CHT.

• Authors: Elio Mazzone, Francesco A Mistretta, Sophie Knipper, Zhe Tian, Carlotta Palumbo, Giorgio Gandaglia, Denis Soulieres, Derya Tilki, Francesco Montorsi, Shahrokh F Shariat, Fred Saad, Alberto Briganti, Pierre I Karakiewicz
• Journal: Clinical genitourinary cancer (Clin Genitourin Cancer) Vol. 17 Issue 6 Pg. e1153-e1162 (12 2019) ISSN: 1938-0682 [Electronic] United States
• PMID: 31515197 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Chemical References

• Antineoplastic Agents

Topics

• Adult
• Antineoplastic Agents (therapeutic use)
• Chemotherapy, Adjuvant (statistics & numerical data, trends)
• Follow-Up Studies
• Humans
• Lymph Node Excision (statistics & numerical data, trends)
• Male
• Neoplasm Staging
• Neoplasms, Germ Cell and Embryonal (mortality, pathology, therapy)
• Orchiectomy
• Propensity Score
• Retroperitoneal Space (surgery)
• Retrospective Studies
• Risk Assessment
• SEER Program (statistics & numerical data)
• Survival Rate
• Testicular Neoplasms (mortality, pathology, therapy)
• Testis (pathology, surgery)
• United States (epidemiology)
• Watchful Waiting (statistics & numerical data, trends)
• Young Adult