Stage I Non-Seminomatous Testicular Cancer: Long-Term Follow-Up with Surveillance Approach Post-Orchiectomy

Abstract

Introduction: Adjuvant treatment for patients with stage I non-seminomatous germ cell tumors (NSGCTs) could be active surveillance (AS), chemotherapy, or retroperitoneal lymph node dissection. AS is the preferred option in most cases. The aim of this study was to evaluate long-term survival and prognostic factors in our population with AS approach.

Methods: We collected information from patients with stage I NSGCT of the testis in medical records from 1995 to 2016. Patients had negative serum tumor markers and imaging of the chest, abdomen, and pelvis with no evidence of metastasis. At relapse, if occurs, patients were treated with chemotherapy, surgery, or both. The Kaplan-Meier method was used to estimate survival. Relationships with outcomes were analyzed using multivariable Cox regression and log-rank analysis.

Results: A total of 457 patients were included. The median age at diagnosis was 25 years. The median follow-up was 65.3 months (range 12-270 months). Relapses were detected in 92 (20%) patients with a median time to recurrence of 7.1 months (range 1.1-123 months). Retroperitoneal lymph nodes were the most common site of relapsed (41.3%), and most patients presented biochemical and imaging recurrence (67.4%). Vascular invasion (VI) was significantly associated with recurrence (HR 2.38 [95% CI: 1.24-4.56], p = 0.008) in the multivariate analysis and rete testis invasion in the univariate analysis (p = 0.027). After salvage treatment, 83 (91.1%) patients were disease free. The overall survival was 98.25% at 20 years.

Conclusions: AS is an effective non-adapted risk-based approach in patients with stage I NSGCT. Almost 100% are alive at 20 years. Nearly all relapses were cured with salvage therapy. Toxicity related to adjuvant treatments, as well as overtreatment, could be avoided.

Keywords: Non-seminoma; Stage I; Surveillance; Survival; Testicular cancer.