Smith A E, Zielinski R, Grimison P, Honeyball F
Western Cancer Centre, Dubbo Base Hospital, Dubbo, Australia; Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, Australia; School of Medicine, Notre Dame University Australia, Sydney, Australia.
Central West Cancer Care Centre, Orange Base Hospital, Orange, Australia; Department of Medicine, Western Sydney University, Sydney, Australia.
Clin Genitourin Cancer. 2025 Aug;23(4):102365. doi: 10.1016/j.clgc.2025.102365. Epub 2025 Apr 22.
Active surveillance (AS) is the preferred management for most patients with stage 1 testicular germ cell tumors (GCT) after orchidectomy as it avoids chemotherapy in up to 85% of patients. International guidelines recommend a combination of imaging, serum tumor markers and physical examination. The aim of this review was to analyze the diagnostic yield of physical examination for detecting relapse in these patients.
Systematic review of the literature from 1976 to 2024 detailing method of relapse detection for patients with stage I GCT managed with AS. Studies commencing after 1990 were assigned to the 'Modern Cohort' and those prior to this date were assigned to the "Older Cohort." Descriptive statistical analysis of discrete data was performed to determine recurrence and proportion of patients, where relevant. The chi squared test was used to determine statistical significance.
Twenty articles were identified representing 2232 (20%) relapses amongst 11,414 patients managed with AS. Relapses were detected by imaging alone in 60%, tumor markers alone in 24%, imaging and markers in 15%, and physical examination in 1.5%. Comparing the Modern cohort (n = 4771) to the older cohort (n = 6643), there were fewer relapses detected by physical examination (0.3% vs. 2%, P = .01) and more relapses detected by imaging alone (71% vs. 55%, P < .00001).
Almost all relapses are detected by routine imaging, serum tumor markers or a combination of these methods. Physical examination alone rarely identified relapses, particularly in the Modern cohort which we hypothesize was driven by improvement in imaging techniques. AS can be conducted safely without mandatory physical examination.
主动监测（AS）是大多数1期睾丸生殖细胞肿瘤（GCT）患者睾丸切除术后的首选管理方式，因为它可使高达85%的患者避免化疗。国际指南推荐将影像学检查、血清肿瘤标志物和体格检查相结合。本综述的目的是分析体格检查对这些患者复发检测的诊断效能。
对1976年至2024年的文献进行系统综述，详细阐述接受AS管理的I期GCT患者的复发检测方法。1990年后开始的研究被归入“现代队列”，在此日期之前的研究被归入“较老队列”。对离散数据进行描述性统计分析，以确定复发情况和患者比例（如适用）。采用卡方检验确定统计学意义。
共纳入20篇文章，代表11414例接受AS管理的患者中有2232例（20%）复发。仅通过影像学检查发现复发的占60%，仅通过肿瘤标志物发现的占24%，通过影像学和标志物发现的占15%，通过体格检查发现的占1.5%。将现代队列（n = 4771）与较老队列（n = 6643）进行比较，通过体格检查发现的复发较少（0.3%对2%，P = .01），仅通过影像学检查发现的复发较多（71%对55%，P < .00001）。
几乎所有复发都是通过常规影像学检查、血清肿瘤标志物或这些方法的组合检测到的。仅体格检查很少能发现复发，特别是在现代队列中，我们推测这是由影像学技术的改进所致。可以在不进行强制性体格检查的情况下安全地进行AS。
