Contemporary Assessment of Long-Term Survival Rates in Patients With Stage I Nonseminoma Germ-Cell Tumor of the Testis
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Contemporary Assessment of Long-Term Survival Rates in Patients With Stage I Nonseminoma Germ-Cell Tumor of the Testis : Population-Based Comparison Between Surveillance and Active Treatment After Initial Orchiectomy. / Mazzone, Elio; Mistretta, Francesco A; Knipper, Sophie; Tian, Zhe; Palumbo, Carlotta; Gandaglia, Giorgio; Soulieres, Denis; Tilki, Derya; Montorsi, Francesco; Shariat, Shahrokh F; Saad, Fred; Briganti, Alberto; Karakiewicz, Pierre I.
in: CLIN GENITOURIN CANC, Jahrgang 17, Nr. 6, 12.2019, S. e1153-e1162.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Contemporary Assessment of Long-Term Survival Rates in Patients With Stage I Nonseminoma Germ-Cell Tumor of the Testis
T2 - Population-Based Comparison Between Surveillance and Active Treatment After Initial Orchiectomy
AU - Mazzone, Elio
AU - Mistretta, Francesco A
AU - Knipper, Sophie
AU - Tian, Zhe
AU - Palumbo, Carlotta
AU - Gandaglia, Giorgio
AU - Soulieres, Denis
AU - Tilki, Derya
AU - Montorsi, Francesco
AU - Shariat, Shahrokh F
AU - Saad, Fred
AU - Briganti, Alberto
AU - Karakiewicz, Pierre I
N1 - Copyright © 2019 Elsevier Inc. All rights reserved.
PY - 2019/12
Y1 - 2019/12
N2 - BACKGROUND: Historical data demonstrated similar survival outcomes in patients with stage I nonseminoma germ-cell tumor of the testis (NSGCTT) subjected to either surveillance or active treatment (AT) after orchiectomy. However, data with long-term follow-up are unavailable. We tested contemporary treatment rates and their effect on cancer-specific mortality (CSM) and other-cause mortality (OCM) relative to surveillance, as well as after stratification between chemotherapy (CHT) versus retroperitoneal lymph node dissection (RPLND).PATIENTS AND METHODS: We identified patients with stage I NSGCTT with initial orchiectomy within the Surveillance, Epidemiology, and End Results (SEER) database (1988-2015). Subsequent surveillance versus CHT versus RPLND use rates were reported. Cumulative incidence plots and multivariable competing-risks regression (CRR) models were used after propensity score (PS) matching. These tests first compared surveillance versus AT (CHT vs. RPLND) and subsequently CHT versus RPLND.RESULTS: Of 5034 patients with stage I NSGCTT, 61.2%, 24.9%, and 13.9%, respectively, underwent surveillance, CHT, and RPLND. Between 1988 and 2015, surveillance (estimated annual percentage change [EAPC]: +1.1%, P < .001) and CHT (EAPC: +2.3%, P < .001) rates increased. RPLND rates decreased (EAPC: -5.7%; P < .001). After PS matching, CRR models failed to identify AT as an independent predictor of lower mortality relative to surveillance. However, after PS matching, CRR models identified RPLND as an independent predictor of lower CSM (hazard ratio, 0.26; P = .002) relative to CHT. No difference in OCM rates was recorded (hazard ratio, 1.25; P = .2).CONCLUSION: Surveillance and CHT use rates increased while RPLND decreased in the last two decades. Virtually the same outcomes were recorded between surveillance and AT. However, within AT, RPLND was associated with lower CSM than CHT.
AB - BACKGROUND: Historical data demonstrated similar survival outcomes in patients with stage I nonseminoma germ-cell tumor of the testis (NSGCTT) subjected to either surveillance or active treatment (AT) after orchiectomy. However, data with long-term follow-up are unavailable. We tested contemporary treatment rates and their effect on cancer-specific mortality (CSM) and other-cause mortality (OCM) relative to surveillance, as well as after stratification between chemotherapy (CHT) versus retroperitoneal lymph node dissection (RPLND).PATIENTS AND METHODS: We identified patients with stage I NSGCTT with initial orchiectomy within the Surveillance, Epidemiology, and End Results (SEER) database (1988-2015). Subsequent surveillance versus CHT versus RPLND use rates were reported. Cumulative incidence plots and multivariable competing-risks regression (CRR) models were used after propensity score (PS) matching. These tests first compared surveillance versus AT (CHT vs. RPLND) and subsequently CHT versus RPLND.RESULTS: Of 5034 patients with stage I NSGCTT, 61.2%, 24.9%, and 13.9%, respectively, underwent surveillance, CHT, and RPLND. Between 1988 and 2015, surveillance (estimated annual percentage change [EAPC]: +1.1%, P < .001) and CHT (EAPC: +2.3%, P < .001) rates increased. RPLND rates decreased (EAPC: -5.7%; P < .001). After PS matching, CRR models failed to identify AT as an independent predictor of lower mortality relative to surveillance. However, after PS matching, CRR models identified RPLND as an independent predictor of lower CSM (hazard ratio, 0.26; P = .002) relative to CHT. No difference in OCM rates was recorded (hazard ratio, 1.25; P = .2).CONCLUSION: Surveillance and CHT use rates increased while RPLND decreased in the last two decades. Virtually the same outcomes were recorded between surveillance and AT. However, within AT, RPLND was associated with lower CSM than CHT.
KW - Adult
KW - Antineoplastic Agents/therapeutic use
KW - Chemotherapy, Adjuvant/statistics & numerical data
KW - Follow-Up Studies
KW - Humans
KW - Lymph Node Excision/statistics & numerical data
KW - Male
KW - Neoplasm Staging
KW - Neoplasms, Germ Cell and Embryonal/mortality
KW - Orchiectomy
KW - Propensity Score
KW - Retroperitoneal Space/surgery
KW - Retrospective Studies
KW - Risk Assessment
KW - SEER Program/statistics & numerical data
KW - Survival Rate
KW - Testicular Neoplasms/mortality
KW - Testis/pathology
KW - United States/epidemiology
KW - Watchful Waiting/statistics & numerical data
KW - Young Adult
U2 - 10.1016/j.clgc.2019.08.009
DO - 10.1016/j.clgc.2019.08.009
M3 - SCORING: Journal article
C2 - 31515197
VL - 17
SP - e1153-e1162
JO - CLIN GENITOURIN CANC
JF - CLIN GENITOURIN CANC
SN - 1558-7673
IS - 6
ER -
