Petrelli Fausto, Coinu Andrea, Cabiddu Mary, Ghilardi Mara, Borgonovo Karen, Lonati Veronica, Barni Sandro
Oncology Department, Medical Oncology Unit, Azienda Ospedaliera Treviglio, Treviglio (BG), Italy.
Oncology Department, Medical Oncology Unit, Azienda Ospedaliera Treviglio, Treviglio (BG), Italy.
Clin Genitourin Cancer. 2015 Oct;13(5):428-34. doi: 10.1016/j.clgc.2015.04.005. Epub 2015 Apr 20.
Testicular stage I seminoma has a remarkable cure rate with orchiectomy alone. The benefit of adjuvant therapy is questionable, and a direct comparison with active surveillance is lacking. We performed a meta-analysis to evaluate the benefit of adjuvant radiotherapy (RT) or chemotherapy (CT) compared with surveillance alone on relapse-free survival (RFS), overall survival (OS), and noncancer-related mortality in patients with stage I seminoma.
We performed a systematic search of PubMed, EMBASE, Web of Science, SCOPUS, and the Cochrane Register of Controlled Trials. Meta-analysis was performed using the fixed- or random-effects models. The primary endpoint was 5-year RFS, and secondary endpoints were 5-year OS and 5-year noncancer-related mortality, reported as odds ratios (ORs) and 95% confidence intervals (CIs).
A total of 13 trials (11 retrospective and 2 prospective cohort series), including 12,075 patients with stage I seminoma, were analyzed. The relapse rates were 3.9% versus 14.8% in the adjuvant therapy and surveillance arms, respectively. Overall, adjuvant therapy significantly improved 5-year RFS (OR, 0.17; 95% CI, 0.1-0.29; P < .00001), but not 5-year OS (OR, 1.03; 95% CI, 0.46-2.28; P = .94). Mortality due to other causes was not significantly increased with CT or RT.
Adjuvant RT and CT reduce recurrence risk by 80% of stage I seminoma. However, they do not increase OS or noncancer-related mortality. Both treatment options can be offered to patients with stage I seminoma, taking into consideration the side effects and high cure rate of testicular cancer at relapse.
睾丸I期精原细胞瘤仅行睾丸切除术就有显著的治愈率。辅助治疗的益处存在疑问，且缺乏与主动监测的直接比较。我们进行了一项荟萃分析，以评估辅助放疗（RT）或化疗（CT）与单纯监测相比，对I期精原细胞瘤患者无复发生存期（RFS）、总生存期（OS）和非癌症相关死亡率的益处。
我们对PubMed、EMBASE、科学网、Scopus和Cochrane对照试验注册库进行了系统检索。采用固定效应或随机效应模型进行荟萃分析。主要终点是5年RFS，次要终点是5年OS和5年非癌症相关死亡率，以比值比（OR）和95%置信区间（CI）报告。
共分析了13项试验（11项回顾性和2项前瞻性队列研究系列），包括12075例I期精原细胞瘤患者。辅助治疗组和监测组的复发率分别为3.9%和14.8%。总体而言，辅助治疗显著改善了5年RFS（OR，0.17；95%CI，0.1 - 0.29；P <.00001），但未改善5年OS（OR，1.03；95%CI，0.46 - 2.28；P =.94）。CT或RT并未显著增加其他原因导致的死亡率。
辅助RT和CT可将I期精原细胞瘤的复发风险降低80%。然而，它们并未增加OS或非癌症相关死亡率。考虑到睾丸癌复发时的副作用和高治愈率，这两种治疗选择均可提供给I期精原细胞瘤患者。
