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High risk NSGCT: case for surveillance
World Journal of Urology, 07/24/09

Kakiashvili DM et al. - In a study to assess the use of initial active surveillance with treatment delayed until relapse for clinical stage (CS) I nonseminomatous germ cell testicular tumors (NSGCT), it was found that nonrisk adapted active surveillance is the preferred management strategy for all CS I NSGCT pts including those at high-risk, providing near 100% cure rate with reduced overall treatment burden. Approximately half of the high-risk pts will be spared unnecessary treatment with little or no increased risk.

Methods

From 1981 to 2005, 371 pts with CS I NSGCT were placed on an active surveillance protocol.
Recurrence patterns, predictors of relapse, disease specific (DS) and overall survival (OS) were measured.
Outcomes were stratified into 2 cohorts by their time of diagnosis [initial, 157 pts (1981–1992); recent, 214 pts (1993–2005)].

Results

Median follow-up was 6.3 yrs; median time to relapse was 7.1 mos.
Lympho-vascular invasion and pure embryonal carcinoma were independent predictors of relapse.
In the initial cohort, 66/157 (42.0%) were high-risk and 36/66 (54.5%) relapsed vs 17/91 (18.7%) low-risk.
In the recent cohort, 59/214 (27.6%) pts were high-risk and 29/59 (49.2%) recurred, vs 22/155 (14.2%) low-risk.
5-yr DSS and OS were 99.2 and 98.2%, respectively.

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