Non-risk-adapted surveillance in clinical stage I nonseminomatous XXXX : the Princess Margaret Hospital's experience.

@entity1 @entity2971 @entity5 @entity189 @entity3457
BACKGROUND: Since 1981 Princess Margaret Hospital has used initial @entity3457 ( @entity3457 ) with delayed treatment at relapse as the preferred management for all @entity1 with clinical stage I nonseminomatous @entity2971 (NSGCT). OBJECTIVE: Our aim was to report our overall @entity3457 experience and compare outcomes over different periods using this non-risk-adapted approach. DESIGN, SETTING, AND @entity1 : Three hundred and seventy-one @entity1 with stage I NSGCT were managed by @entity3457 from 1981 to 2005. For analysis by time period, @entity1 were divided into two cohorts by diagnosis date: initial cohort, 1981-1992 (n=157), and recent cohort, 1993-2005 (n=214). INTERVENTION: @entity1 were followed at regular intervals, and treatment was only given for relapse. MEASUREMENTS: Recurrence rates, time to relapse, risk factors for recurrence, disease-specific survival, and overall survival were determined. RESULTS AND LIMITATIONS: With a median follow-up of 6.3 yr, 104 @entity1 (28%) relapsed: 53 of 157 (33.8%) in the initial group and 51 of 214 (23.8%) in the recent group. Median time to relapse was 7 mo. Lymphovascular invasion (p<0.0001) and pure @entity189 (p=0.02) were independent predictors of recurrence; 125 @entity1 (33.7%) were designated as high risk based on the presence of one or both factors. In the initial cohort, 66 of 157 @entity1 (42.0%) were high risk and 36 of 66 @entity1 (54.5%) relapsed versus 17 of 91 low-risk @entity1 (18.7%) (p<0.0001). In the recent cohort, 59 of 214 @entity1 (27.6%) were high risk and 29 of 59 had a recurrence (49.2%) versus 22 of 155 low-risk @entity1 (14.2%) (p<0.0001). Three @entity1 (0.8%) died from @entity5 . The estimated 5-yr disease-specific survival was 99.3% in the initial group and 98.9% in the recent one. CONCLUSIONS: Non-risk-adapted surveillance is an effective, simple strategy for the management of all stage I NSGCT.
