Initial surveillance in men with marker negative clinical stage IIA non-seminomatous germ cell tumours
(2024) In BJU International- Abstract
Objectives: To assess whether extended surveillance with repeated computed tomography (CT) scans for patients with clinical stage IIA (CS IIA; <2 cm abdominal node involvement) and negative markers (Mk−) non-seminomatous germ cell tumours (NSGCTs) can identify those with true CS I. To assess the rate of benign lymph nodes, teratoma, and viable cancer in retroperitoneal lymph node dissection (RPLND) histopathology for patients with CS IIA Mk− NSGCT. Patients and methods: Observational prospective population-based study of patients diagnosed 2008–2019 with CS IIA Mk− NSGCT in the Swedish and Norwegian Testicular Cancer Group (SWENOTECA) registry. Patients were managed with surveillance, with CT scans, and tumour markers every sixth... (More)
Objectives: To assess whether extended surveillance with repeated computed tomography (CT) scans for patients with clinical stage IIA (CS IIA; <2 cm abdominal node involvement) and negative markers (Mk−) non-seminomatous germ cell tumours (NSGCTs) can identify those with true CS I. To assess the rate of benign lymph nodes, teratoma, and viable cancer in retroperitoneal lymph node dissection (RPLND) histopathology for patients with CS IIA Mk− NSGCT. Patients and methods: Observational prospective population-based study of patients diagnosed 2008–2019 with CS IIA Mk− NSGCT in the Swedish and Norwegian Testicular Cancer Group (SWENOTECA) registry. Patients were managed with surveillance, with CT scans, and tumour markers every sixth week for a maximum of 18 weeks. Patients with radiological regression were treated as CS I, if progression with chemotherapy, and remaining CS IIA Mk− disease with RPLND. The end-point was the number and percentage of patients down-staged to CS I on surveillance and rate of RPLND histopathology presented as benign, teratoma, or viable cancer. Results: Overall, 126 patients with CS IIA Mk− NSGCT were included but 41 received therapy upfront. After surveillance for a median (range) of 6 (6–18) weeks, 23/85 (27%) patients were in true CS I and four (5%) progressed. Of the remaining 58 patients with lasting CS IIA Mk− NSGCT, 16 received chemotherapy and 42 underwent RPLND. The RPLND histopathology revealed benign lymph nodes in 11 (26%), teratoma in two (6%), and viable cancer in 29 (70%) patients. Conclusions: Surveillance with repeated CT scans can identify patients in true CS I, thus avoiding overtreatment. The RPLND histopathology in patients with CS IIA Mk− NSGCT had a high rate of cancer and a low rate of teratoma.
(Less)
- author
- organization
- publishing date
- 2024
- type
- Contribution to journal
- publication status
- epub
- subject
- keywords
- chemotherapy, germ cell tumour, non-seminoma, retroperitoneal lymph node dissection, testicular cancer
- in
- BJU International
- publisher
- Wiley-Blackwell
- external identifiers
-
- pmid:38293778
- scopus:85183908049
- ISSN
- 1464-4096
- DOI
- 10.1111/bju.16289
- language
- English
- LU publication?
- yes
- id
- 86d2cc00-0be6-4470-8253-75b139a6729c
- date added to LUP
- 2024-02-27 09:33:03
- date last changed
- 2024-04-12 10:38:29
@article{86d2cc00-0be6-4470-8253-75b139a6729c,
abstract = {{<p>Objectives: To assess whether extended surveillance with repeated computed tomography (CT) scans for patients with clinical stage IIA (CS IIA; <2 cm abdominal node involvement) and negative markers (Mk−) non-seminomatous germ cell tumours (NSGCTs) can identify those with true CS I. To assess the rate of benign lymph nodes, teratoma, and viable cancer in retroperitoneal lymph node dissection (RPLND) histopathology for patients with CS IIA Mk− NSGCT. Patients and methods: Observational prospective population-based study of patients diagnosed 2008–2019 with CS IIA Mk− NSGCT in the Swedish and Norwegian Testicular Cancer Group (SWENOTECA) registry. Patients were managed with surveillance, with CT scans, and tumour markers every sixth week for a maximum of 18 weeks. Patients with radiological regression were treated as CS I, if progression with chemotherapy, and remaining CS IIA Mk− disease with RPLND. The end-point was the number and percentage of patients down-staged to CS I on surveillance and rate of RPLND histopathology presented as benign, teratoma, or viable cancer. Results: Overall, 126 patients with CS IIA Mk− NSGCT were included but 41 received therapy upfront. After surveillance for a median (range) of 6 (6–18) weeks, 23/85 (27%) patients were in true CS I and four (5%) progressed. Of the remaining 58 patients with lasting CS IIA Mk− NSGCT, 16 received chemotherapy and 42 underwent RPLND. The RPLND histopathology revealed benign lymph nodes in 11 (26%), teratoma in two (6%), and viable cancer in 29 (70%) patients. Conclusions: Surveillance with repeated CT scans can identify patients in true CS I, thus avoiding overtreatment. The RPLND histopathology in patients with CS IIA Mk− NSGCT had a high rate of cancer and a low rate of teratoma.</p>}},
author = {{Gerdtsson, Axel and Negaard, Helene F.S. and Almås, Bjarte and Bergdahl, Anna Grenabo and Cohn-Cedermark, Gabriella and Glimelius, Ingrid and Halvorsen, Dag and Haugnes, Hege Sagstuen and Hedlund, Annika and Hellström, Martin and Holmberg, Göran and Karlsdóttir, Ása and Kjellman, Anders and Larsen, Signe Melsen and Thor, Anna and Wahlqvist, Rolf and Ståhl, Olof and Tandstad, Torgrim}},
issn = {{1464-4096}},
keywords = {{chemotherapy; germ cell tumour; non-seminoma; retroperitoneal lymph node dissection; testicular cancer}},
language = {{eng}},
publisher = {{Wiley-Blackwell}},
series = {{BJU International}},
title = {{Initial surveillance in men with marker negative clinical stage IIA non-seminomatous germ cell tumours}},
url = {{http://dx.doi.org/10.1111/bju.16289}},
doi = {{10.1111/bju.16289}},
year = {{2024}},
}