Outcomes and treatment patterns as a function of time in stage IS testicular seminoma: a population-based analysis

To assess outcomes and treatment patterns as a function of time in stage IS pure testicular seminoma patients using a population-based analysis.

One thousand one hundred and fifty-two stage I testicular seminoma patients with normal alpha-fetoprotein levels were identified in the Surveillance, Epidemiology, and End Results (SEER) database between 1998 and 2005. Three hundred and twenty-three of these patients had persistent elevations of their serum lactate dehydrogenase (LDH) and/or beta subunit of human chorionic gonadotropin (bHCG) level post-orchiectomy, i.e., "stage IS" disease.

Median follow-up was 86 months. There was persistent elevation of LDH or bHCG levels post-orchiectomy in 19% and 15% stage I patients, respectively. Post-orchiectomy LDH and bHCG did not predict overall survival (OS) or cause-specific survival (CSS) in stage IS patients. There was a decrease in utilization of adjuvant RT in stage IS patients from 1998 (100%) to 2005 (58%, p=.01). The annual percentage decrease in RT utilization for stage IS patients was -5.4% (95% confidence interval: -7.7% to -3.9%). Modern, linear accelerator-based RT was associated with an improvement in OS. However, longer follow up is necessary to determine if the OS benefit persists.

Post-orchiectomy LDH and bHCG did not predict OS or CSS in stage IS patients. There was a steady decrease in utilization of adjuvant RT in the United States in stage IS testicular seminoma patients between 1998 and 2005. This may be due to the increasing popularity of chemotherapy or active surveillance.