First Indicator of Relapse in Testicular Cancer and Implications for Follow-up: Analysis of the Swiss Austrian German Testicular Cancer Cohort Study (SAG TCCS).

Follow-up Germ cell tumours Testicular cancer

Journal

European urology open science
ISSN: 2666-1683
Titre abrégé: Eur Urol Open Sci
Pays: Netherlands
ID NLM: 101771568

Informations de publication

Date de publication:
Oct 2024
Historique:
accepted: 14 08 2024
medline: 23 9 2024
pubmed: 23 9 2024
entrez: 23 9 2024
Statut: epublish

Résumé

Follow-up for patients with testicular cancer should ensure early detection of relapses. Optimal schedules and minimum requirements for cross-sectional imaging are not clearly defined, and guideline recommendations differ. Our aim was to analyse the clinical impact of different imaging modalities for detection of relapse in a large prospective cohort (Swiss Austrian German Testicular Cancer Cohort Study, SAG TCCS). Patients with seminoma or nonseminoma were prospectively enrolled between January 2014 and February 2023 after initial treatment ( We analysed data for 1006 patients (64% seminoma, 36% nonseminoma); 76% had stage I disease. Active surveillance was the most frequent management strategy (65%). Recurrence occurred in 82 patients, corresponding to a 5-yr relapse-free survival rate of 90.1% (95% confidence interval 87.7-92.1%). Median follow-up for patients without relapse was 38.4 mo (interquartile range 21.6-61.0). Cross-sectional imaging of the abdomen was the most important indicator of relapse 57%, abdominal CT accounting for 46% and MRI for 11%. Marker elevation indicated relapse in 24% of cases. Chest X-ray was the least useful modality, indicating relapse in just 2% of cases. On the basis of findings from our prospective register, we have adapted a follow-up schedules with an emphasis on abdominal imaging and a reduction in chest X-rays. This schedule might provide additional guidance for clinicians and will be prospectively evaluated as SAG TCCS continues to enrol patients. We analysed the value of different types of imaging scans for detection of relapse of testicular cancer. We used our findings to propose an optimum follow-up schedule for patients with testicular cancer.

Sections du résumé

Background and objective UNASSIGNED
Follow-up for patients with testicular cancer should ensure early detection of relapses. Optimal schedules and minimum requirements for cross-sectional imaging are not clearly defined, and guideline recommendations differ. Our aim was to analyse the clinical impact of different imaging modalities for detection of relapse in a large prospective cohort (Swiss Austrian German Testicular Cancer Cohort Study, SAG TCCS).
Methods UNASSIGNED
Patients with seminoma or nonseminoma were prospectively enrolled between January 2014 and February 2023 after initial treatment (
Key findings and limitations UNASSIGNED
We analysed data for 1006 patients (64% seminoma, 36% nonseminoma); 76% had stage I disease. Active surveillance was the most frequent management strategy (65%). Recurrence occurred in 82 patients, corresponding to a 5-yr relapse-free survival rate of 90.1% (95% confidence interval 87.7-92.1%). Median follow-up for patients without relapse was 38.4 mo (interquartile range 21.6-61.0). Cross-sectional imaging of the abdomen was the most important indicator of relapse 57%, abdominal CT accounting for 46% and MRI for 11%. Marker elevation indicated relapse in 24% of cases. Chest X-ray was the least useful modality, indicating relapse in just 2% of cases.
Conclusions and clinical implications UNASSIGNED
On the basis of findings from our prospective register, we have adapted a follow-up schedules with an emphasis on abdominal imaging and a reduction in chest X-rays. This schedule might provide additional guidance for clinicians and will be prospectively evaluated as SAG TCCS continues to enrol patients.
Patient summary UNASSIGNED
We analysed the value of different types of imaging scans for detection of relapse of testicular cancer. We used our findings to propose an optimum follow-up schedule for patients with testicular cancer.

Identifiants

DOI: 10.1016/j.euros.2024.08.008 PMID: 39308640 PMC: PMC11416594
pubmed: 39308640
doi: 10.1016/j.euros.2024.08.008
pii: S2666-1683(24)00633-5
pmc: PMC11416594
doi:

Types de publication

Journal Article

Langues

eng

Pagination

68-74

Informations de copyright

© 2024 The Author(s).

Auteurs

Stefanie Fischer (S)

Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.

Silke Gillessen (S)

Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
Università della Svizzera Italiana, Lugano, Switzerland.

Odile Stalder (O)

Department of Clinical Research, CTU Bern, University of Bern, Bern, Switzerland.

Angelika Terbuch (A)

Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Comprehensive Cancer Center Graz, Graz, Austria.

Richard Cathomas (R)

Division of Medical Oncology/Haematology, Cantonal Hospital Graubünden, Chur, Switzerland.

Florian A Schmid (FA)

Department of Urology, University Hospital Zurich, Zurich, Switzerland.

Deborah Zihler (D)

Department of Medical Oncology and Haematology, Cantonal Hospital Aarau, Aarau, Switzerland.

Beat Müller (B)

Department of Medical Oncology, Cantonal Hospital Luzern, Luzern, Switzerland.

Christian D Fankhauser (CD)

Department of Urology, Cantonal Hospital Luzern, Luzern, Switzerland.

Anita Hirschi-Blickenstorfer (A)

Onkozentrum Hirslanden, Clinic Hirslanden, Zurich, Switzerland.

Luis Alex Kluth (LA)

Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany.

Bettina Seifert (B)

Department of Medical Oncology, Cantonal Hospital Liestal, Basel, Switzerland.

Arnoud J Templeton (AJ)

Department of Medical Oncology, St. Claraspital/St. Clara Research and Faculty of Medicine, University of Basel, Basel, Switzerland.

Walter Mingrone (W)

Department of Medical Oncology, Cantonal Hospital Olten, Olten, Switzerland.

Mark-Peter Ufe (MP)

Ammerland Klinik, Westerstede, Germany.

Natalie Fischer (N)

Department of Medical Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland.

Jörg Beyer (J)

Department of Medical Oncology, University Hospital Bern, Bern, Switzerland.

Regina Woelky (R)

Department of Medical Oncology, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland.

Aurelius Omlin (A)

Onkozentrum Zurich und Uro-Onkologisches Zentrum, Hirslanden Klinik Zurich, Zurich, Switzerland.

Ursula Vogl (U)

Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
Università della Svizzera Italiana, Lugano, Switzerland.

Katharina Hoppe (K)

Stadtspital Triemli Zurich, Zurich, Switzerland.

Jörn Kamradt (J)

Urologie Zentrum Bern und Hirslanden Bern, Bern Switzerland.

Sacha I Rothschild (SI)

Department of Medical Oncology and Comprehensive Cancer Center, University Hospital Basel, Basel, Switzerland.
Department of Medical Oncology/Hematology and Comprehensive Cancer Centre Cantonal Hospital Baden, Baden, Switzerland.

Christian Rothermundt (C)

Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.

Classifications MeSH