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. 2023 Sep 15;23(1):870.
doi: 10.1186/s12885-023-11388-y.

Excellent survival in relapsed stage I testicular cancer

Philip Speicher  1   2 , Christian D Fankhauser  3 , Anja Lorch  4 , Davide Ardizzone  5 , Simon Helnwein  2 , Dennis Hoch  2 , Thomas Hermanns  6 , Jörg Beyer  7 , Dilara Akhoundova  2   8
Affiliations

Excellent survival in relapsed stage I testicular cancer

Philip Speicher et al. BMC Cancer. .

Abstract

Background: Two thirds of patients with germ-cell cancer (GCC) present as clinical stage I (CSI). Following orchiectomy, active surveillance (AS) has become their standard management. However, 15-50% of patients eventually relapse with metastatic disease after AS. Relapses need to be detected early in order to achieve cure and avoid overtreatment.

Methods: We retrospectively analyzed consecutive GCC patients treated at two Swiss academic centers between 2010 and 2020. Patients with stage IS and extragonadal primaries were excluded. We compared disease characteristics and survival outcomes of patients relapsed from initial CSI to patients with de novo metastatic disease. Primary endpoint was the IGCCCG category at the time of relapse. Main secondary endpoints were progression-free survival (PFS) and overall survival (OS).

Results: We identified 360 GCC patients with initial CSI and 245 de novo metastatic patients. After a median follow-up of 47 months, 81 of 360 (22.5%) CSI patients relapsed: 41 seminoma (Sem) and 40 non-seminoma (NSem) patients. All Sems relapsed in the IGCCCG good prognosis group. NSem relapsed with good 29/40 (72.5%) and intermediate 11/40 (27.5%) prognostic features; 95.1% of relapses occurred within five years post-orchiectomy. Only 3 relapsed NSem patients died from metastatic disease. Five-year OS for relapsed CSI patients was 100% for Sem and 87% (95% CI: 61-96%) for NSem patients; five-year PFS was 92% (95% CI: 77-97) and 78% (95% CI: 56-90) for Sem and NSem, respectively. When stratified by IGCCCG prognostic groups, good risk relapsed patients had a trend towards better OS and PFS as compared to de novo metastatic patients.

Conclusions: GCC patients who relapse after initial CSI can be detected early by active surveillance and have an excellent survival.

Keywords: Active surveillance; Clinical stage I; Follow-up; Germ-cell cancer; IGCCCG prognostic group; Relapse; Testicular cancer.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Schematic diagram illustrating patient distribution into cohorts A and B, as well as stratification by IGCCCG prognostic groups and histology. Abbreviations: GCC: germ cell cancer; IGCCCG: International Germ Cell Cancer Cooperative Group; *For serum-LDH values, 250 U/l was selected as upper limit of normal (ULN). 1.5xULN threshold was used to classify patients into the IGCCCG intermediate risk group
Fig. 2
Fig. 2
Histogram illustrating time to relapse (months) after initial CSI management. 95.1% of relapses occurred within five years post-orchiectomy
Fig. 3
Fig. 3
Kaplan–Meier curves illustrating OS and PFS for IGCCCG good prognosis relapsed (cohort A) from initial CSI vs de novo metastatic (cohort B) GCC patients. A 5-year OS was 97% vs 93% (p = 0.162) and B 5-year PFS, 88% vs 74% (p = 0.066) for cohort A vs B, respectively
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