Use of prognostic factors of disease progression in the treatment of patients with stage i nonseminomatous testicular tumors
Ondrus, D.
Bratislavske Lekarske Listy 100(1): 61-65
1999
ISSN/ISBN: 0006-9248 PMID: 10493000 Document Number: 503133
Surveillance after orchiectomy alone becomes popular for the management of CS I NSGCTT. Effort to identify patients at high risk of relapse leads to searching for prognostic factors of CS I NSGCTT. The aim of this study was to identify those patients in whom surveillance policy is less likely to be successful. 95 CS I NSGCTT patients were stratified to different risk-adapted therapeutic approaches according to histopathologic findings of primary tumor removed by inguinal orchiectomy. Twenty nine patients (group A) with vascular invasion and majority of embryonal carcinoma component in the primary tumor were treated with adjuvant BEP chemotherapy. Disease progression was experienced in one patient (3.4%) 19 months of follow-up. Other 28 patients live without evidence of disease (NED) with a mean follow-up period of 31.1 months after orchiectomy. Six patients (group B) with vascular invasion and majority of teratomatous elements in the primary tumor have been followed 52.7 months after orchiectomy in average. They were treated with primary retroperitoneal lymph node dissection (RPLND). Two of them (33.3%) had pathologic stage II after RPLND and underwent subsequent chemotherapy. The progression of disease was observed in one patient (16.7%) who died 29 months following orchiectomy, another 5 patients live with NED. Sixty patients (group C) without vascular invasion have been followed for 40.6 months in average after orchiectomy. They were kept under close surveillance, consisted of regular follow-up with tumor markers, chest x-ray and CT of the retroperitoneum. Disease progression was observed in 11 (18.3%) patients after a mean duration of 11.8 months after orchiectomy. They were treated with BEP chemotherapy. All of them live with NED (five of them need postchemotherapy RPLND) with mean duration of follow-up 24.8 months after treatment. The overall survival rate of all 95 patients was 98.9% with mean duration of 38.5 months (range, 2-83+). Surveillance policy is recommend only in patients without vascular invasion in the primary tumor. (Fig. 1, Ref. 32.)