For this study, the authors retrospectively reviewed the medical records of all testicular cancer patients treated at a single institution from 2006-2016. Demographic, clinical, laboratory, imaging, pathological, treatment and surveillance data were obtained. Analysis of associations was conducted using Fisher’s exact test for categorical variables and Student t-test for continuous variables. Kaplan-Meier survival analysis was used to calculate relapse free survival rates.
Among 109 testicular cancer patients, 25 (22.7%) with borderline size lymph nodes were assigned to an active surveillance protocol. Median age at the time of orchiectomy was 37.2 years (IQR, 23.9-40.3). With a median follow-up of 3.9 years (IQR 1.7-6.5), overall survival rate was 100%. Nine of 25 patients (36%) relapsed and were treated within a median of 4.9 months (IQR 2.2-5.5). Median follow-up for 16 patients who did not relapse was 3.4 years (IQR 1.5-5.4). Relapse-free survival was 71% (95%CI 48-85), and 61% (95%CI 38-77) at one and two years, respectively. Orchiectomy pathology included pure seminoma in 72% of patients, and a nonseminomatous tumor in 28%. Tumor histology was not associated with likelihood of relapse (p = 0.66). The median lymph node diameter at the time of diagnosis was 11 mm (IQR 9-12, mean 10.4), and was not associated with likelihood of relapse (p = 0.34). Patients who relapsed during follow-up were significantly younger at the time of testicular cancer diagnosis than patients who did not relapse (median age 23.9 years [IQR 19.6-35.2] and 39.2 years [IQR 34.3-47.9] respectively, p = 0.0056).
The authors concluded that based on results of their single institutional study, surveillance alone for testicular cancer patients with borderline size lymph nodes of undetermined significance at diagnosis is a possible option and may help avoid over treatment in 60% of these patients.
Presented by: Nadav Milk, MD Meir Medical Center, Kfar Saba, Israel
Co-Authors: Ilan Leibovitch, Daniel Keizman, Hadas Dresler, Itay Sternberg; Meir Medical Center, Kfar Saba, Israel; Meir Medical Center, Kfar-Saba, Israel
Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, @zklaassen_md at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA