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Stage I Non-Seminomatous Testicular Cancer: Long-Term Follow-Up with Surveillance Approach Post-Orchiectomy
Jorge Martínez-Cedillo, Diego A Díaz-García1, César Infante-González2
1Medical Oncology Department, Instituto Nacional de Cancerología, Mexico City, Mexico.
Oncology
|February 16, 2025
Summary
Active surveillance is an effective approach for stage I non-seminomatous germ cell tumors (NSGCTs), with nearly all patients alive at 20 years. Relapses are curable with salvage therapy, avoiding adjuvant treatment toxicity.
Area of Science:
- Oncology
- Urology
- Cancer Research
Background:
- Adjuvant treatment options for stage I non-seminomatous germ cell tumors (NSGCTs) include active surveillance (AS), chemotherapy, and retroperitoneal lymph node dissection.
- Active surveillance is frequently the preferred management strategy for these patients.
Purpose of the Study:
- To evaluate the long-term survival outcomes and identify prognostic factors in patients with stage I NSGCT managed with an active surveillance approach.
Main Methods:
- A retrospective review of medical records for 457 patients diagnosed with stage I NSGCT of the testis between 1995 and 2016.
- Kaplan-Meier method for survival estimation and multivariable Cox regression/log-rank analysis for outcome associations.
Main Results:
- The median follow-up was 65.3 months, with 20% of patients experiencing relapse.
- Vascular invasion was significantly associated with recurrence (HR 2.38).
- Overall survival reached 98.25% at 20 years, with 91.1% of relapsed patients disease-free after salvage treatment.
Conclusions:
- Active surveillance is an effective, risk-adapted strategy for stage I NSGCT, achieving excellent long-term survival.
- Salvage therapy effectively cures nearly all relapses, mitigating the need for potentially toxic adjuvant treatments and overtreatment.
