Nayan Madhur, Hamilton Robert J
Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada.
Adv Urol. 2018 Feb 19;2018:7182014. doi: 10.1155/2018/7182014. eCollection 2018.
Testicular cancer is the most common malignancy in young men, and the incidence is increasing in most countries worldwide. The vast majority of patients present with clinical stage I disease, and surveillance is being increasingly adopted as the preferred management strategy. At the time of diagnosis, patients on surveillance are often counselled about their risk of relapse based on risk factors present at diagnosis, but this risk estimate becomes less informative in patients that have survived a period of time without experiencing relapse. Conditional survival estimates, on the other hand, provide information on a patient's evolving risk of relapse over time. In this review, we describe the concept of conditional survival and its applications for surveillance of clinical stage I seminoma and nonseminoma germ cell tumours. These estimates can be used to tailor surveillance protocols based on future risk of relapse within risk subgroups of seminoma and nonseminoma, which may reduce the burden of follow-up for some patients, physicians, and the health care system. Furthermore, conditional survival estimates provide patients with a meaningful, evolving risk estimate and may be helpful to reassure patients and reduce potential anxiety of being on surveillance.
睾丸癌是年轻男性中最常见的恶性肿瘤，全球大多数国家的发病率都在上升。绝大多数患者初诊时为临床I期疾病，监测正日益成为首选的管理策略。在诊断时，接受监测的患者通常会根据诊断时存在的风险因素接受关于复发风险的咨询，但对于那些在一段时间内未复发存活下来的患者，这种风险估计的信息量就会减少。另一方面，条件生存估计提供了患者随时间推移复发风险演变的信息。在本综述中，我们描述了条件生存的概念及其在临床I期精原细胞瘤和非精原细胞瘤生殖细胞肿瘤监测中的应用。这些估计可用于根据精原细胞瘤和非精原细胞瘤风险亚组内未来的复发风险制定监测方案，这可能会减轻一些患者、医生和医疗保健系统的随访负担。此外，条件生存估计为患者提供了一个有意义的、不断演变的风险估计，可能有助于让患者安心，并减少接受监测的潜在焦虑。
