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Platinum Priority – Testis Cancer Editorial by Peter B. Østergren, Jens Sønksen and Mikkel Fode on pp. 271–272 of this issue| Volume 73, ISSUE 2, P262-270, February 01, 2018

Contemporary Treatment Patterns and Outcomes for Clinical Stage IS Testicular Cancer

  • Author Footnotes
    † These authors have contributed equally to this manuscript.
    Sophia C. Kamran
    Footnotes
    † These authors have contributed equally to this manuscript.
    Affiliations
    Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA

    Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, USA
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  • Author Footnotes
    † These authors have contributed equally to this manuscript.
    Thomas Seisen
    Footnotes
    † These authors have contributed equally to this manuscript.
    Affiliations
    Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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  • Sarah C. Markt
    Affiliations
    Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, USA
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  • Mark A. Preston
    Affiliations
    Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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  • Quoc-Dien Trinh
    Affiliations
    Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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  • Lindsay A. Frazier
    Affiliations
    Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
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  • Toni K. Choueiri
    Affiliations
    Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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  • Neil E. Martin
    Affiliations
    Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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  • Paul L. Nguyen
    Affiliations
    Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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  • Clair J. Beard
    Correspondence
    Corresponding author. Testicular Cancer Center, Dana-Farber/Brigham and Women's Cancer Center, Department of Radiation Oncology, Brigham and Women's Hospital, 45 Francis Street, Boston, MA 02115, USA. Tel.: +1-617-732-7948; Fax: +1-617-264-5242.
    Affiliations
    Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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  • Author Footnotes
    † These authors have contributed equally to this manuscript.

      Abstract

      Background

      Controversy exists regarding the optimal management strategy for clinical stage IS seminomatous (SGCT) and nonseminomatous germ cell tumors (NSGCT) of the testis.

      Objective

      To assess contemporary treatment patterns and outcomes for clinical stage IS testicular cancer.

      Design, setting, and participants

      Using the National Cancer Data Base (2004–2012), we identified 1362 patients with clinical stage IS SGCT and NSGCT of the testis, treated with either adjuvant treatment (AT) or observation.

      Outcome measures and statistical analysis

      We calculated the annual percent change (APC) to assess treatment trends. Inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier curves and Cox regression analyses were used to compare overall survival (OS) between AT and observation groups. Analyses were stratified by histologic type.

      Results and limitations

      Overall, there were 581 (43%) and 781 (57%) men with SGCT and NSGCT, respectively. Among men with SGCT, the use of AT decreased over the study period (APC = –2.7, 95% confidence interval [CI]: –4.4, –1.1, p = 0.001). The 5-yr IPTW-adjusted rates of OS were 99% and 97% in the AT and observation groups, respectively (hazard ratio = 0.36, 95% CI: 0.12, 1.14, p = 0.08). Among men with NSGCT, the use of AT remained stable over the study period (APC = +0.8, 95% CI: –0.7, +2.2, p = 0.29). The 5-yr IPTW-adjusted rates of OS were 97% and 95% in the AT and observation groups, respectively (HR = 0.66, 95% CI: 0.27, 1.61, p = 0.36). Limitations include the lack of full treatment details and cancer-specific survival information.

      Conclusions

      Trends in the use of AT significantly decreased over time for SGCT, while it remained stable for NSGCT. Nonetheless, we report 5-yr OS rates of ≥95% for both histologies without any significant benefit with the use of AT. Further studies are warranted to confirm these findings.

      Patient summary

      We evaluated treatment trends and outcomes for stage IS testicular cancer. We found that treatment changed over time for seminoma and remained stable for nonseminoma; there was no significant survival benefit in the use of adjuvant treatment versus observation for both seminomatous and nonseminomatous germ cell tumors.

      Keywords

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