Prognostic factors for relapse in stage I testicular seminoma treated with surveillance

• Published in: The Journal of urology Vol. 157; no. 5; p. 1705
• Main Authors: Warde, P, Gospodarowicz, M K, Banerjee, D, Panzarella, T, Sugar, L, Catton, C N, Sturgeon, J F, Moore, M, Jewett, M A
• Format: Journal Article
• Language: English
• Published: United States 01.05.1997
• Subjects: Actuarial Analysis; Adult; Aged; Aged, 80 and over; Disease Progression; Follow-Up Studies; Humans; Male; Middle Aged; Multivariate Analysis; Neoplasm Recurrence, Local - epidemiology; Neoplasm Staging; Orchiectomy; Prognosis; Seminoma - mortality; Seminoma - pathology; Seminoma - surgery; Testicular Neoplasms - mortality; Testicular Neoplasms - pathology; Testicular Neoplasms - surgery
• ISSN: 0022-5347
• DOI: 10.1016/S0022-5347(01)64839-0

We sought to identify prognostic factors predictive of disease progression in patients with clinical stage I seminoma on surveillance following orchiectomy. Between January 1981 and December 1993, 201 patients 20 to 86 years old (median age 34) with clinical stage I seminoma were placed on surveillance following orchiectomy. The potential prognostic factors studied included age, tumor size, mitotic count, S phase fraction, ploidy, presence of small vessel invasion, syncytiotrophoblasts and tumor infiltrating lymphocytes, expression of beta-human chorionic gonadotropin and low molecular weight keratin on immunohistochemistry. With a median followup of 6.1 years (range 1.3 to 12.3) 31 patients had relapse for an actuarial 5-year relapse-free rate of 84.9%. The 5-year actuarial survival rate was 97.1% and the cause specific survival rate was 99.5%. On univariate analysis factors predictive of relapse were tumor size (5-year relapse-free rate 88 and 67% for tumors 6 cm. or less and greater than 6 cm., respectively, p = 0.004), age (5-year relapse-free rate 79 and 91% for age 34 years or younger versus older than 34 years, respectively, p = 0.009) and presence of small vessel invasion (5-year relapse-free rate 86 versus 69%, p = 0.01). On multivariate analysis age and tumor size were predictive of relapse, while small vessel invasion approached statistical significance. The risk of relapse in 57 patients with none of the 3 adverse prognostic factors (age greater than 34 years, tumor 6 cm. or smaller and no small vessel invasion) was 6%. We identified age, size of the primary tumor and small vessel invasion as important prognostic factors for relapse in patients with stage I seminoma treated with surveillance. Further followup and assessment of biological factors are needed to optimize selection of patients at a high risk for relapse who should receive immediate postoperative therapy.