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High risk NSGCT: case for surveillance.
David Michael Kakiashvili1, Alvaro Zuniga, Michael A S Jewett
1Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, ON, M5G 2M9, Canada. dkmd@rogers.com
World Journal of Urology
|July 18, 2009
Summary
Active surveillance for clinical stage I nonseminomatous germ cell tumors (NSGCT) is effective, offering a high cure rate with reduced treatment burden. This approach spares many high-risk patients unnecessary interventions without increasing risk.
Area of Science:
- Oncology
- Urology
- Clinical Research
Background:
- Active surveillance, retroperitoneal lymph node dissection, and chemotherapy are options for high-risk clinical stage (CS) I nonseminomatous germ cell tumors (NSGCT).
- Princess Margaret Hospital has preferred active surveillance since 1981 for all CS I NSGCT, enabling natural history assessment of high-risk tumors.
Purpose of the Study:
- To evaluate the outcomes of active surveillance for CS I NSGCT.
- To identify predictors of relapse and assess survival rates in patients managed with active surveillance.
Main Methods:
- A cohort of 371 patients with CS I NSGCT were managed under an active surveillance protocol from 1981 to 2005.
- Recurrence patterns, relapse predictors, disease-specific survival (DSS), and overall survival (OS) were analyzed.
- Outcomes were compared between two diagnostic cohorts: initial (1981-1992) and recent (1993-2005).
Main Results:
- Lympho-vascular invasion and pure embryonal carcinoma were independent predictors of relapse.
- In the initial cohort, 54.5% of high-risk patients relapsed versus 18.7% of low-risk patients (P < 0.0001).
- In the recent cohort, 49.2% of high-risk patients relapsed versus 14.2% of low-risk patients (P < 0.0001).
- The 5-year DSS and OS were 99.2% and 98.2%, respectively.
Conclusions:
- Non-risk-adapted active surveillance is the preferred management for all CS I NSGCT patients, including high-risk cases.
- This strategy achieves a near 100% cure rate while minimizing the overall treatment burden.
- Approximately half of high-risk patients can avoid unnecessary treatment without significant added risk.
