![]() The data were contained in prospectively managed databases at the three institutions. The purpose of this study was to assess the performance of the 2002 prognostic model in an independent dataset of patients managed with surveillance for stage I seminoma.Īfter research ethics board approval, individual data on 685 patients were obtained from 3 centers: Rigshospitalet, Copenhagen Princess Margaret Cancer Centre, Toronto British Columbia Cancer Agency, Vancouver. In addition, the model has never been subject to full validation in an independent dataset. ![]() This approach is still considered as experimental in consensus guidelines 13, 14. This model has been adopted by some groups to investigate “risk-adapted” therapy 12 despite the fact that the model did not have a very useful discriminatory ability. ![]() This model was based on two pathological factors in the primary tumor specimen, tumor size and the presence or absence of rete testis invasion. These include the need for a relatively long period of follow-up, with regular cross sectional imaging and the lack of a robust prognostic model to identify those men at higher risk of relapse.Ī prognostic model derived from multi-institutional data to estimate risk of relapse in stage I seminoma patients managed with surveillance was published in 2002 11. ![]() However, there are some issues with respect to surveillance that have resulted in reluctance to adopt this approach in stage I seminoma 9, 10. Only those men who develop relapse will receive additional treatment, while all others, who are cured of their disease by orchiectomy alone, will not be exposed to the risk of adverse effects associated with adjuvant therapy. Although adjuvant therapy (RT or carboplatin) remains an option for some patients, surveillance is now well established as the preferred management option for most patients in this setting. Historically adjuvant radiotherapy (RT) has been the most popular treatment option after radical orchiectomy for stage I testicular seminoma 1 however, better understanding of the natural history of the disease, the advent of highly successful combination chemotherapy in patients with metastatic disease, and accumulating long-term data suggesting potentially serious consequences of adjuvant RT 2 – 4 lead to the investigation of alternative strategies, thus significantly altering management options 5 – 8. However, primary tumor size retained prognostic importance and a scale of relapse risk based on the unit increment of tumor size was developed to help guide patients and clinicians in decision making. A clinically useful, highly discriminating prognostic model remains elusive in stage I seminoma surveillance as we were unable to validate the previously developed model. The 3-year relapse risk based on the primary tumor size alone increased from 9% for 1 cm primary tumor to 26% for 8 cm tumor. In multivariable analysis, tumor size above median (cutpoint of 3 cm) was a predictor for relapse, HR 1.87 (95% CI 1.15, 3.06), whereas rete testis invasion HR 1.36, (95% CI 0.81, 2.28) was not statistically significant. ≥3 cm) was associated with increased risk of relapse but rete testis invasion was not, nor was age and small vessel invasion. In univariate analysis, median tumor size (<3 cm vs. Median follow-up was 3.85 years (0.1–10.29), 88 patients relapsed and 5-year relapse-free rate was 85%. Specifically median tumor size and rete testis invasion was tested to evaluate the performance of the published model. Variables including age and pathology of the primary tumor: small vessel invasion, tumor size, and invasion of rete testis were analyzed. Individual data on 685 stage I seminoma surveillance patients managed between 19 at three cancer centers were retrospectively analyzed. A prognostic model for relapse risk in stage I seminoma managed by surveillance after orchiectomy has been developed but has not been independently validated.
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