Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark.
European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium.
Br J Cancer. 2023 Nov;129(11):1759-1765. doi: 10.1038/s41416-023-02443-3. Epub 2023 Sep 30.
Active surveillance after orchiectomy is the preferred management in clinical stage I (CSI) germ-cell tumours (GCT) associated with a 15 to 30% relapse rate.
In the IGCCCG Update database, we compared the outcomes of gonadal disseminated GCT relapsing from initial CSI to outcomes of patients with de novo metastatic GCT.
A total of 1014 seminoma (Sem) [298 (29.4%) relapsed from CSI, 716 (70.6%) de novo] and 3103 non-seminoma (NSem) [626 (20.2%) relapsed from CSI, 2477 (79.8%) de novo] were identified. Among Sem, no statistically significant differences in PFS and OS were found between patients relapsing from CSI and de novo metastatic disease [5-year progression-free survival (5y-PFS) 87.6% versus 88.5%; 5-year overall survival (5y-OS) 93.2% versus 96.1%). Among NSem, PFS and OS were higher overall in relapsing CSI patients (5y-PFS 84.6% versus 80.0%; 5y-OS 93.3% versus 88.7%), but there were no differences within the same IGCCCG prognostic groups (HR = 0.89; 95% CI: 0.70-1.12). Relapses in the intermediate or poor prognostic groups occurred in 11/298 (4%) Sem and 112/626 (18%) NSem.
Relapsing CSI GCT patients expect similar survival compared to de novo metastatic patients of the same ICCCCG prognostic group. Intermediate and poor prognosis relapses from initial CSI expose patients to unnecessary toxicity from more intensive treatments.
睾丸切除术（orchiectomy）后进行主动监测是临床 I 期（CSI）生殖细胞肿瘤（GCT）的首选治疗方法，复发率为 15%至 30%。
在 IGCCCG 更新数据库中，我们比较了初始 CSI 复发的性腺播散性 GCT 患者与初发转移性 GCT 患者的结局。
共发现 1014 例精原细胞瘤（Sem）[298 例（29.4%）从 CSI 复发，716 例（70.6%）初发]和 3103 例非精原细胞瘤（NSem）[626 例（20.2%）从 CSI 复发，2477 例（79.8%）初发]。在 Sem 中，从 CSI 复发与初发转移性疾病的患者在 PFS 和 OS 方面无统计学差异[5 年无进展生存率（5y-PFS）为 87.6%对 88.5%；5 年总生存率（5y-OS）为 93.2%对 96.1%]。在 NSem 中，复发 CSI 患者的 PFS 和 OS 总体较高（5y-PFS 为 84.6%对 80.0%；5y-OS 为 93.3%对 88.7%），但在相同 IGCCCG 预后组中无差异（HR=0.89；95%CI：0.70-1.12）。在中等或不良预后组中，298 例 Sem 中有 11 例（4%）和 626 例 NSem 中有 112 例（18%）发生复发。
与相同 IGCCCG 预后组的初发转移性患者相比，复发 CSI GCT 患者的生存预期相似。从中期和不良预后 CSI 复发的患者会因更密集的治疗而遭受不必要的毒性。
