Contemporary Assessment of Survival Rates in Stage I Testicular Seminoma

A Population-Based Comparison Between Surveillance and Active Treatment After Orchiectomy

Francesco A. Mistretta, Elio Mazzone, Carlotta Palumbo, Sophie Knipper, Zhe Tian, Sebastiano Nazzani, Jean Baptiste Lattouf, Gennaro Musi, Paul Perrotte, Emanuele Montanari, Shahrokh F. Shariat, Francesco Montorsi, Fred Saad, Ottavio de Cobelli, Pierre I. Karakiewicz

Research output: Contribution to journalArticle

Abstract

Background: We tested contemporary surveillance and active treatment (AT) that included chemotherapy (CHT) and radiotherapy (RT) rates for stage I testicular seminoma patients, as well as cancer-specific mortality (CSM) and other-cause mortality (OCM) rates. Patients and Methods: Within the Surveillance, Epidemiology, and End Results database (1988-2015) we identified 11,206 stage I testicular seminoma patients. Surveillance versus CHT versus RT use rates were investigated using estimated annual percentage change (EAPC) analyses. After propensity score (PS) matching, cumulative incidence plots and multivariable competing risks regression models (MCRRMs) tested for CSM and OCM. Results: Of all 11,206 patients, 4434 (40%), 918 (8%), and 5854 (52%), respectively, underwent surveillance, CHT, or RT after initial orchiectomy. Surveillance (EAPC: 7.5%; P < .001) and CHT (EAPC: 13.5%; P < .001) rates increased over time, whereas RT rates decreased (EAPC: −3.8%; P < .001). After PS matching, in MCRRMs surveillance was an independent predictor of CSM, relative to AT (hazard ratio [HR], 2.59; P = .04). Conversely, surveillance versus AT did not affect OCM (HR, 1.52; P = .051). All other analyses that focused on CSM and OCM, namely surveillance versus RT, surveillance versus CHT, and RT versus CHT resulted in nonsignificant differences (all P > .5). Conclusion: Surveillance and CHT use in stage I testicular seminoma rates increased, whereas RT rate decreased over time. A protective effect of AT defined as either RT or CHT was identified on CSM, relative to surveillance. This protective effect was not described for OCM. No differences in survival were recorded, when individual management strategies (surveillance vs. RT vs. CHT) were compared with each other. Within the Surveillance, Epidemiology, and End Results database (1988-2015) we identified 11,206 stage I testicular seminoma patients, who underwent respectively surveillance (40%), chemotherapy (CHT; 8%), or radiotherapy (RT; 52%) after orchiectomy. Surveillance and CHT rates increased over time, whereas RT rates decreased. A protective effect of active treatment defined as either RT or CHT was identified on cancer-specific mortality, relative to surveillance.

Original languageEnglish
Pages (from-to)e793-e801
JournalClinical Genitourinary Cancer
Volume17
Issue number4
DOIs
Publication statusPublished - Jan 1 2019

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Seminoma
Orchiectomy
Radiotherapy
Survival Rate
Drug Therapy
Population
Mortality
Therapeutics
Neoplasms
Epidemiology
Databases
Propensity Score

Keywords

  • Chemotherapy
  • Radiotherapy
  • SEER program
  • Surveillance
  • Testicular neoplasm

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Contemporary Assessment of Survival Rates in Stage I Testicular Seminoma : A Population-Based Comparison Between Surveillance and Active Treatment After Orchiectomy. / Mistretta, Francesco A.; Mazzone, Elio; Palumbo, Carlotta; Knipper, Sophie; Tian, Zhe; Nazzani, Sebastiano; Lattouf, Jean Baptiste; Musi, Gennaro; Perrotte, Paul; Montanari, Emanuele; Shariat, Shahrokh F.; Montorsi, Francesco; Saad, Fred; de Cobelli, Ottavio; Karakiewicz, Pierre I.

In: Clinical Genitourinary Cancer, Vol. 17, No. 4, 01.01.2019, p. e793-e801.

Research output: Contribution to journalArticle

Mistretta, Francesco A. ; Mazzone, Elio ; Palumbo, Carlotta ; Knipper, Sophie ; Tian, Zhe ; Nazzani, Sebastiano ; Lattouf, Jean Baptiste ; Musi, Gennaro ; Perrotte, Paul ; Montanari, Emanuele ; Shariat, Shahrokh F. ; Montorsi, Francesco ; Saad, Fred ; de Cobelli, Ottavio ; Karakiewicz, Pierre I. / Contemporary Assessment of Survival Rates in Stage I Testicular Seminoma : A Population-Based Comparison Between Surveillance and Active Treatment After Orchiectomy. In: Clinical Genitourinary Cancer. 2019 ; Vol. 17, No. 4. pp. e793-e801.
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abstract = "Background: We tested contemporary surveillance and active treatment (AT) that included chemotherapy (CHT) and radiotherapy (RT) rates for stage I testicular seminoma patients, as well as cancer-specific mortality (CSM) and other-cause mortality (OCM) rates. Patients and Methods: Within the Surveillance, Epidemiology, and End Results database (1988-2015) we identified 11,206 stage I testicular seminoma patients. Surveillance versus CHT versus RT use rates were investigated using estimated annual percentage change (EAPC) analyses. After propensity score (PS) matching, cumulative incidence plots and multivariable competing risks regression models (MCRRMs) tested for CSM and OCM. Results: Of all 11,206 patients, 4434 (40{\%}), 918 (8{\%}), and 5854 (52{\%}), respectively, underwent surveillance, CHT, or RT after initial orchiectomy. Surveillance (EAPC: 7.5{\%}; P < .001) and CHT (EAPC: 13.5{\%}; P < .001) rates increased over time, whereas RT rates decreased (EAPC: −3.8{\%}; P < .001). After PS matching, in MCRRMs surveillance was an independent predictor of CSM, relative to AT (hazard ratio [HR], 2.59; P = .04). Conversely, surveillance versus AT did not affect OCM (HR, 1.52; P = .051). All other analyses that focused on CSM and OCM, namely surveillance versus RT, surveillance versus CHT, and RT versus CHT resulted in nonsignificant differences (all P > .5). Conclusion: Surveillance and CHT use in stage I testicular seminoma rates increased, whereas RT rate decreased over time. A protective effect of AT defined as either RT or CHT was identified on CSM, relative to surveillance. This protective effect was not described for OCM. No differences in survival were recorded, when individual management strategies (surveillance vs. RT vs. CHT) were compared with each other. Within the Surveillance, Epidemiology, and End Results database (1988-2015) we identified 11,206 stage I testicular seminoma patients, who underwent respectively surveillance (40{\%}), chemotherapy (CHT; 8{\%}), or radiotherapy (RT; 52{\%}) after orchiectomy. Surveillance and CHT rates increased over time, whereas RT rates decreased. A protective effect of active treatment defined as either RT or CHT was identified on cancer-specific mortality, relative to surveillance.",
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T2 - A Population-Based Comparison Between Surveillance and Active Treatment After Orchiectomy

AU - Mistretta, Francesco A.

AU - Mazzone, Elio

AU - Palumbo, Carlotta

AU - Knipper, Sophie

AU - Tian, Zhe

AU - Nazzani, Sebastiano

AU - Lattouf, Jean Baptiste

AU - Musi, Gennaro

AU - Perrotte, Paul

AU - Montanari, Emanuele

AU - Shariat, Shahrokh F.

AU - Montorsi, Francesco

AU - Saad, Fred

AU - de Cobelli, Ottavio

AU - Karakiewicz, Pierre I.

PY - 2019/1/1

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N2 - Background: We tested contemporary surveillance and active treatment (AT) that included chemotherapy (CHT) and radiotherapy (RT) rates for stage I testicular seminoma patients, as well as cancer-specific mortality (CSM) and other-cause mortality (OCM) rates. Patients and Methods: Within the Surveillance, Epidemiology, and End Results database (1988-2015) we identified 11,206 stage I testicular seminoma patients. Surveillance versus CHT versus RT use rates were investigated using estimated annual percentage change (EAPC) analyses. After propensity score (PS) matching, cumulative incidence plots and multivariable competing risks regression models (MCRRMs) tested for CSM and OCM. Results: Of all 11,206 patients, 4434 (40%), 918 (8%), and 5854 (52%), respectively, underwent surveillance, CHT, or RT after initial orchiectomy. Surveillance (EAPC: 7.5%; P < .001) and CHT (EAPC: 13.5%; P < .001) rates increased over time, whereas RT rates decreased (EAPC: −3.8%; P < .001). After PS matching, in MCRRMs surveillance was an independent predictor of CSM, relative to AT (hazard ratio [HR], 2.59; P = .04). Conversely, surveillance versus AT did not affect OCM (HR, 1.52; P = .051). All other analyses that focused on CSM and OCM, namely surveillance versus RT, surveillance versus CHT, and RT versus CHT resulted in nonsignificant differences (all P > .5). Conclusion: Surveillance and CHT use in stage I testicular seminoma rates increased, whereas RT rate decreased over time. A protective effect of AT defined as either RT or CHT was identified on CSM, relative to surveillance. This protective effect was not described for OCM. No differences in survival were recorded, when individual management strategies (surveillance vs. RT vs. CHT) were compared with each other. Within the Surveillance, Epidemiology, and End Results database (1988-2015) we identified 11,206 stage I testicular seminoma patients, who underwent respectively surveillance (40%), chemotherapy (CHT; 8%), or radiotherapy (RT; 52%) after orchiectomy. Surveillance and CHT rates increased over time, whereas RT rates decreased. A protective effect of active treatment defined as either RT or CHT was identified on cancer-specific mortality, relative to surveillance.

AB - Background: We tested contemporary surveillance and active treatment (AT) that included chemotherapy (CHT) and radiotherapy (RT) rates for stage I testicular seminoma patients, as well as cancer-specific mortality (CSM) and other-cause mortality (OCM) rates. Patients and Methods: Within the Surveillance, Epidemiology, and End Results database (1988-2015) we identified 11,206 stage I testicular seminoma patients. Surveillance versus CHT versus RT use rates were investigated using estimated annual percentage change (EAPC) analyses. After propensity score (PS) matching, cumulative incidence plots and multivariable competing risks regression models (MCRRMs) tested for CSM and OCM. Results: Of all 11,206 patients, 4434 (40%), 918 (8%), and 5854 (52%), respectively, underwent surveillance, CHT, or RT after initial orchiectomy. Surveillance (EAPC: 7.5%; P < .001) and CHT (EAPC: 13.5%; P < .001) rates increased over time, whereas RT rates decreased (EAPC: −3.8%; P < .001). After PS matching, in MCRRMs surveillance was an independent predictor of CSM, relative to AT (hazard ratio [HR], 2.59; P = .04). Conversely, surveillance versus AT did not affect OCM (HR, 1.52; P = .051). All other analyses that focused on CSM and OCM, namely surveillance versus RT, surveillance versus CHT, and RT versus CHT resulted in nonsignificant differences (all P > .5). Conclusion: Surveillance and CHT use in stage I testicular seminoma rates increased, whereas RT rate decreased over time. A protective effect of AT defined as either RT or CHT was identified on CSM, relative to surveillance. This protective effect was not described for OCM. No differences in survival were recorded, when individual management strategies (surveillance vs. RT vs. CHT) were compared with each other. Within the Surveillance, Epidemiology, and End Results database (1988-2015) we identified 11,206 stage I testicular seminoma patients, who underwent respectively surveillance (40%), chemotherapy (CHT; 8%), or radiotherapy (RT; 52%) after orchiectomy. Surveillance and CHT rates increased over time, whereas RT rates decreased. A protective effect of active treatment defined as either RT or CHT was identified on cancer-specific mortality, relative to surveillance.

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KW - SEER program

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