Compliance with follow-up for patients with stage 1 testicular germ cell tumour.
compliance
follow-up
germ cell tumour
recurrence
surveillance
Journal
ANZ journal of surgery
ISSN: 1445-2197
Titre abrégé: ANZ J Surg
Pays: Australia
ID NLM: 101086634
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
03
10
2019
revised:
15
05
2020
accepted:
04
06
2020
pubmed:
4
7
2020
medline:
15
5
2021
entrez:
4
7
2020
Statut:
ppublish
Résumé
This study aimed to evaluate the compliance and loss-to-follow-up (LTFU) rate in patients with stage 1 testicular germ cell tumours (GCTs) on active surveillance protocol at a metropolitan health service in Melbourne, Australia. Patients with stage 1 testicular GCTs diagnosed between 30 June 2012 and 30 June 2018 were identified. Compliance of surveillance programme was classified into three groups: 'adequate', 'missed appointment(s)' or 'LTFU'. The LTFU rate was assessed using Kaplan-Meier methodology. Log-rank test was used for univariate analyses. Forty-eight patients had stage 1 testicular GCTs during the 6-year period. Twenty-two (46%) of them were managed with active surveillance and 26 (54%) of them were given adjuvant therapy. Compliance with active surveillance was assessed as adequate in 12 (55%), missed appointment(s) in six (27%) and LFTU in four (18%). The LTFU rates in patients with active surveillance at 12, 24 and 36 months were 9%, 9% and 19%, respectively. The LTFU rate in patients with active surveillance was not significantly different from patients who received adjuvant therapy (hazard ratio 0.71 (95% confidence intervals 0.22, 2.30), P = 0.56). Three (14%) of the 22 patients managed with active surveillance had recurrence of disease, all of which occurred in the first 12 months, compared to two (8%) of the 26 patients who had adjuvant therapy. Active surveillance is a commonly utilized management option for stage 1 testicular GCTs, but has a LTFU rate of almost 20% that may limit its effectiveness. The recurrence rate was comparable to published literature.
Sections du résumé
BACKGROUND
This study aimed to evaluate the compliance and loss-to-follow-up (LTFU) rate in patients with stage 1 testicular germ cell tumours (GCTs) on active surveillance protocol at a metropolitan health service in Melbourne, Australia.
METHODS
Patients with stage 1 testicular GCTs diagnosed between 30 June 2012 and 30 June 2018 were identified. Compliance of surveillance programme was classified into three groups: 'adequate', 'missed appointment(s)' or 'LTFU'. The LTFU rate was assessed using Kaplan-Meier methodology. Log-rank test was used for univariate analyses.
RESULTS
Forty-eight patients had stage 1 testicular GCTs during the 6-year period. Twenty-two (46%) of them were managed with active surveillance and 26 (54%) of them were given adjuvant therapy. Compliance with active surveillance was assessed as adequate in 12 (55%), missed appointment(s) in six (27%) and LFTU in four (18%). The LTFU rates in patients with active surveillance at 12, 24 and 36 months were 9%, 9% and 19%, respectively. The LTFU rate in patients with active surveillance was not significantly different from patients who received adjuvant therapy (hazard ratio 0.71 (95% confidence intervals 0.22, 2.30), P = 0.56). Three (14%) of the 22 patients managed with active surveillance had recurrence of disease, all of which occurred in the first 12 months, compared to two (8%) of the 26 patients who had adjuvant therapy.
CONCLUSION
Active surveillance is a commonly utilized management option for stage 1 testicular GCTs, but has a LTFU rate of almost 20% that may limit its effectiveness. The recurrence rate was comparable to published literature.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
184-186Informations de copyright
© 2020 Royal Australasian College of Surgeons.
Références
Noone AM, Howlader N, Krapcho M et al. (eds). SEER Cancer Statistics Review, 1975-2015. 2018. [Cited 20 Dec, 2019.] Available from URL: https://seer.cancer.gov/csr/1975_2015/ (based on November 2017 SEER data submission, posted to the SEER web site, April 2018).
Australian Institute of Health and Welfare (AIHW). Australian Cancer Incidence and Mortality (ACIM) Books: Testicular Cancer. Canberra: AIHW, 2017. Available from URL: http://www.aihw.gov.au/acim-books.
Cullen MH, Stenning SP, Parkinson MC et al. Short-course adjuvant chemotherapy in high-risk stage I nonseminomatous germ cell tumors of the testis: a Medical Research Council report. J. Clin. Oncol. 1996; 14: 1106-13.
Gilbert DC, Norman AR, Nicholl J, Dearnaley DP, Horwich A, Huddart RA. Treating stage I nonseminomatous germ cell tumours with a single cycle of chemotherapy. BJU Int. 2006; 98: 67-9.
Hamilton C, Horwich A, Easton D, Peckham MJ. Radiotherapy for stage I seminoma testis: results of treatment and complications. Radiother. Oncol. 1986; 6: 115-20.
von der Maase H, Specht L, Jacobsen GK. Surveillance following orchidectomy for stage I seminoma of the testis. Eur. J. Cancer 1993; 29A: 1931-4.
Mead GM, Fossa SD, Oliver RTD et al. Randomized trials in 2466 patients with stage I seminoma: patterns of relapse and follow-up. J. Natl. Cancer Inst. 2011; 103: 241-9.
Horwich A, Shipley J, Huddart R. Testicular germ-cell cancer. Lancet 2006; 367: 754-65.
National Comprehensive Cancer Network. Testicular cancer (version 1.2015). 2015. [Cited 13 Nov 2014.] Available from URL: http://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf
BC Cancer Agency. Management: pure seminomas and nonseminomatous germ cell tumours (with or without seminoma). 2013. [Cited 13 Nov 2014.] Available from URL: http://www.bccancer.bc.ca/health-professionals/professional-resources/cancer-managementguidelines/genitourinary/testis
Albers P, Albrecht W, Algaba F et al. Guidelines on testicular cancer: update March 2011. European Association of Urology. Actas Urol. Esp. 2012; 36: 127-45.
Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trial Group. ANZUP Stage 1 Testicular Cancer Surveillance Recommendations, 2018. [Cited 10 May 2020.] Available from URL: https://www.anzup.org.au/content.aspx?page=recommendations
Grimison P, Houghton B, Chatfield M et al. Patterns of management and surveillance imaging amongst medical oncologists in Australia for stage I testicular cancer. BJU Int. 2013; 112: E35-43.
Groll RJ, Warde P, Jewett MA. A comprehensive systematic review of testicular germ cell tumor surveillance. Crit. Rev. Oncol. Hematol. 2007; 64: 182-97.
Ernst DS, Brasher P, Venner PM et al. Compliance and outcome of patients with stage 1 non-seminomatous germ cell tumors (NSGCT) managed with surveillance programs in seven Canadian centres. Can. J. Urol. 2005; 12: 2575-80.
Hao D, Seidel J, Brant R et al. Compliance of clinical stage I nonseminomatous germ cell tumor patients with surveillance. J. Urol. 1998; 160 (3Pt 1): 768-71.
Honeyball F, Murali-Ganesh R, Hruby G, Grimison P. Compliance of males with stage 1 testicular germ cell tumours on an active surveillance protocol. Intern. Med. J. 2015; 45: 1081-4.
Endo T, Kawai K, Kamba T et al. Risk factors for loss to follow-up during active surveillance of patients with stage I seminoma. Jpn. J. Clin. Oncol. 2014; 44: 355-9.