The association between institution at orchiectomy and outcomes on active surveillance for clinical stage I germ cell tumours

Abstract

Introduction: Institutional experience has been associated with improved outcomes for various malignancies, including testicular cancer. The present study evaluated whether institution at orchiectomy was associated with outcomes on active surveillance (AS) for clinical stage (CS) I germ cell tumours (GCT). Methods: 815 patients with CSI GCT managed with AS at the Princess Margaret Cancer Centre were identified. Princess Margaret is a tertiary academic institution with a multidisciplinary testicular cancer clinic involving radiation oncologists, medical oncologists, and urologists, and has research experience in testicular cancer care. The association between institution of orchiectomy (Princess Margaret vs. Other) and time to progression on AS was analyzed using multivariable Cox proportional hazards models. Academic vs. non-academic institutions were compared in a sensitivity analysis. Results: Patients undergoing orchiectomy at Princess Margaret for non-seminoma GCT were significantly less likely to have pure embryonal carcinoma (EC) in orchiectomy pathology (odds ratio [OR] 0.33; p=0.008) and CSIB disease (OR 0.47; p=0.014). Seminoma characteristics did not differ significantly between institution groups. In non-seminoma GCT, median followup was 5.4 years, 27% progressed on AS, and institution of orchiectomy was not associated with time to progression in either univariate (hazard ratio [HR] 0.79; p=0.33) or multivariable analyses (HR 1.01; p=0.97). In seminoma, median followup was 4.7 years, 12% progressed on AS, and institution of orchiectomy was not associated with progression (univariate: HR 0.87; p=0.73; multivariable: HR 0.98; p=0.96). Sensitivity analyses demonstrated similar results. Conclusions: Among CSI GCT patients managed on AS at a specialized cancer centre, there appears to be no difference in oncologic outcomes based upon the institution where orchiectomy was performed.

Multidisciplinary clinic approach improves overall survival outcomes of patients with metastatic germ-cell tumors

“…Institutional experience, hospital and physician volume have been associated with improved outcomes of testicular cancer [7][8][9][10]. Recent outcome data from large datasets are missing, and the difference in results of patients treated in large volume centers and community centers is unknown.…”

Dissecting the Evolving Risk of Relapse over Time in Surveillance for Testicular Cancer

“…Approximately 70% and 85% of patients with clinical stage I NSGCT and seminoma, respectively, will be cured by orchiectomy alone [ 6 – 8 ]. However, given the potential for disease progression, some advocate primary adjuvant treatment and highlight the benefit of avoiding a more intense salvage regimen in those that do relapse.…”

Safety of Minimizing Intensity of Follow-up on Active Surveillance for Clinical Stage I Testicular Germ Cell Tumors

“…The majority of patients with germ cell tumor (GCT) present with clinical stage I (CSI) disease after orchiectomy that is localized to the testicle with no evidence of metastases on serologic, radiographic, or clinical examinations [1] . In these patients, orchiectomy alone is curative in 70% with nonseminomatous germ cell tumor (NSGCT) and in 85% with seminoma [1] , [2] , [3] . Following orchiectomy, management may include active surveillance, adjuvant chemotherapy, radiotherapy, or retroperitoneal lymph node dissection (RPLND), depending on whether the tumor is seminoma or NSGCT, and risk of relapse.…”