Shorter surveillance follow-up for stage I seminoma may be sufficient

1. A large, retrospective, population-based study of stage I seminoma patients followed by active surveillance post-orchiectomy demonstrated that the majority of relapses occurred within the first 5 years. 

2. The most important prognostic factor for stage I seminoma relapse wa tumor size. 

Evidence Rating Level: 3 (Average)        

Study Rundown: Guidelines for the use of active surveillance in stage I seminoma are highly variable. There has been no consensus as recommendations vary between 5 years post-orchiectomy to life-long follow-up. The authors of this study retrospectively analyzed survival outcomes of 1954 stage I seminoma patients managed by active surveillance and followed for at least 5 years. The results demonstrated that 369/1954 (18.9%) patients experienced relapse. However, the majority of relapses occurred within the first 5 years (median: 13.7 months). Furthermore, nearly all of the relapsing patients belonged to a good prognostic group. Overall, the disease specific survival and overall survival at 15 years were 99.3% and 91.6%, respectively. Multivariate analysis demonstrated that tumor size was the most important prognostic factor for seminoma relapse. This study is the largest cohort of stage I seminoma patients and the results of this study support the guidelines of a 5-year follow-up program post-orchiectomy to avoid unnecessary imaging. However, the study is limited by the retrospective design and additional prospective studies will be required before specific guidelines can be implemented.

Click to read the study in European Urology

Relevant Reading: Active Surveillance Is the Preferred Approach to Clinical Stage I Testicular Cancer

In-Depth [retrospective cohort]: This retrospective review analyzed 1954 adult patients diagnosed with stage I seminoma between 1984 and 2007 as part of the Danish Testicular Cancer database (DaTeCa). The primary outcomes were disease-specific survival (DSS), overall survival (OS), and prognostic factors for relapse.  The median follow-up time was 15.1 years. Overall, 369 patients relapsed over the observation period, 95% (353/369) of which occurred within the first 5 years of follow-up. Kaplan-Meier analysis demonstrated that DSS after 5, 10, and 15 years was 99.6%, 99.4% and 99.3% respectively and OS after 15 years was 91.6%. Multivariate analysis demonstrated that tumor size was the most significant prognostic factor for relapse (HR: 1.59, 95% CI: 1.31-1.92, p<0.0001). Invasion of epididymis (HR: 1.57, 95%CI: 1.04-2.38) and vascular invasion (HR: 1.41, 95% CI: 1.05-1.89) were both statistically significant risk factors for relapse, provided the other was removed from the multivariate model.

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