Gariscsak Peter J, Anson-Cartwright Lynn, Atenafu Eshetu G, Jiang Di Maria, Chung Peter, Bedard Philippe, Warde Padraig, O'Malley Martin, Sweet Joan, Glicksman Rachel M, Hamilton Robert J
School of Medicine, Queen's University, Kingston, Ontario, Canada.
Department of Surgery (Urology), Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
Eur Urol Open Sci. 2022 Apr 27;40:46-53. doi: 10.1016/j.euros.2022.03.010. eCollection 2022 Jun.
We have recommended active surveillance as the preferred management option for clinical stage I (CSI) testicular germ cell tumors (GCTs) since 1980. Over time, the recommended intensity of surveillance has decreased; however, the impact on relapse detection has not been investigated.
To examine relapse rate, time to relapse, extent of disease, and burden of treatment at relapse across decreasing surveillance intensity over time.
CSI GCT patients under active surveillance from 1981 to 2021 were included in this study.
Through four major iterations in both nonseminomatous (NSGCT) and seminoma surveillance schedules, visit frequency, blood testing, and imaging have been decreased successively. Low-dose, noncontrast computed tomography (CT) scans were adopted in 2011. Categorical variables and time to relapse were compared using chi-square and Fisher's exact or Kruskal-Wallis test, respectively.
A total of 1583 consecutive patients (942 with seminoma and 641 with NSGCT) were included. In seminoma, chest x-rays were reduced from 13 to one and CT scans were reduced from 20 to ten. Relapse rate, time to relapse, N or M category, and International Germ Cell Cancer Collaborative Group (IGCCCG) classification did not change. In NSGCT, chest x-rays were reduced from 27 to zero and CT scans were reduced from 11 to five. Relapse rate (from 46.2% to 21.2%, = 0.002) and the median time to relapse (from 6.54 to 4.47 mo, = 0.025) decreased. No difference in relapsed disease burden was identified by N, M, and S category or IGCCCG classification. Treatment burden at relapse and GCT cancer deaths remained similar for seminoma and NSGCT. Limitations include the retrospective design and large time period covered.
Despite considerable reductions in surveillance intensity, we did not observe an increase in disease extent, treatment burden, or GCT cancer deaths upon relapse. These results support that our current lower-intensity active surveillance schedules are safe for managing CSI GCT.
Our current reduced-intensity surveillance schedules for clinical stage I germ cell tumors appear to be safe.
自1980年以来，我们一直推荐将主动监测作为临床I期（CSI）睾丸生殖细胞肿瘤（GCT）的首选管理方案。随着时间的推移，推荐的监测强度有所降低；然而，其对复发检测的影响尚未得到研究。
研究随着时间推移监测强度降低时的复发率、复发时间、疾病范围以及复发时的治疗负担。
设计、背景与参与者：本研究纳入了1981年至2021年期间接受主动监测的CSI GCT患者。
在非精原细胞瘤（NSGCT）和精原细胞瘤的监测方案中，经过四次主要迭代，访视频率、血液检测和影像学检查依次减少。2011年采用了低剂量非增强计算机断层扫描（CT）。分别使用卡方检验、Fisher精确检验或Kruskal-Wallis检验比较分类变量和复发时间。
共纳入1583例连续患者（942例精原细胞瘤患者和641例NSGCT患者）。在精原细胞瘤中，胸部X光检查从13次减少到1次，CT扫描从20次减少到10次。复发率、复发时间、N或M类别以及国际生殖细胞癌协作组（IGCCCG）分类均未改变。在NSGCT中，胸部X光检查从27次减少到0次，CT扫描从11次减少到5次。复发率（从46.2%降至21.2%，P = 0.002）和复发的中位时间（从6.54个月降至4.47个月，P = 0.025）降低。按N、M和S类别或IGCCCG分类，复发疾病负担无差异。精原细胞瘤和NSGCT复发时的治疗负担以及GCT癌症死亡人数保持相似。局限性包括回顾性设计和涵盖的时间跨度大。
尽管监测强度大幅降低，但我们未观察到复发时疾病范围、治疗负担或GCT癌症死亡人数增加。这些结果支持我们目前较低强度的主动监测方案对管理CSI GCT是安全的。
我们目前针对临床I期生殖细胞肿瘤的低强度监测方案似乎是安全的。
