Prognostic Factors for Relapse in Stage I Testicular Seminoma Treated With Surveillance
- 1 May 1997
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Urology
- Vol. 157 (5), 1705-1710
- https://doi.org/10.1016/s0022-5347(01)64839-0
Abstract
We sought to identify prognostic factors predictive of disease progression in patients with clinical stage I seminoma on surveillance following orchiectomy. Between January 1981 and December 1993, 201 patients 20 to 86 years old (median age 34) with clinical stage I seminoma were placed on surveillance following orchiectomy. The potential prognostic factors studied included age, tumor size, mitotic count, S phase fraction, ploidy, presence of small vessel invasion, syncytiotrophoblasts and tumor infiltrating lymphocytes, expression of beta-human chorionic gonadotropin and low molecular weight keratin on immunohistochemistry. With a median followup of 6.1 years (range 1.3 to 12.3) 31 patients had relapse for an actuarial 5-year relapse-free rate of 84.9%. The 5-year actuarial survival rate was 97.1% and the cause specific survival rate was 99.5%. On univariate analysis factors predictive of relapse were tumor size (5-year relapse-free rate 88 and 67% for tumors 6 cm. or less and greater than 6 cm., respectively, p = 0.004), age (5-year relapse-free rate 79 and 91% for age 34 years or younger versus older than 34 years, respectively, p = 0.009) and presence of small vessel invasion (5-year relapse-free rate 86 versus 69%, p = 0.01). On multivariate analysis age and tumor size were predictive of relapse, while small vessel invasion approached statistical significance. The risk of relapse in 57 patients with none of the 3 adverse prognostic factors (age greater than 34 years, tumor 6 cm. or smaller and no small vessel invasion) was 6%. We identified age, size of the primary tumor and small vessel invasion as important prognostic factors for relapse in patients with stage I seminoma treated with surveillance. Further followup and assessment of biological factors are needed to optimize selection of patients at a high risk for relapse who should receive immediate postoperative therapy.Keywords
This publication has 18 references indexed in Scilit:
- Stage I testicular seminoma: results of adjuvant irradiation and surveillance.Journal of Clinical Oncology, 1995
- Surveillance following orchidectomy for stage I seminoma of the testisEuropean Journal Of Cancer, 1993
- Incidence of second primary cancer following testicular cancerEuropean Journal Of Cancer, 1993
- Results of a policy of surveillance in stage I testicular seminomaInternational Journal of Radiation Oncology*Biology*Physics, 1993
- Medical Research Council prospective study of surveillance for stage I testicular teratoma. Medical Research Council Testicular Tumors Working Party.Journal of Clinical Oncology, 1992
- Surveillance following orchidectomy for stage I testicular seminomaBritish Journal of Cancer, 1992
- Stage I Seminoma of the Testis. Adjuvant Radiotherapy or Surveillance?British Journal of Urology, 1991
- Radiotherapy for Stage I seminoma testis: Results of treatment and complicationsRadiotherapy and Oncology, 1986
- Method for analysis of cellular DNA content of paraffin-embedded pathological material using flow cytometry.Journal of Histochemistry & Cytochemistry, 1983
- Recovery from aspermia induced by low-dose radiation in seminoma patientsCancer, 1982