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Lookup NU author(s): Dr Christoph OingORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2022, The Author(s). Purpose: Testicular germ cell tumours (GCTs) represent the most common malignancy in young adult males with two thirds of all cases presenting with clinical stage I (CSI). Active surveillance is the management modality mostly favoured by current guidelines. This systematic review assesses the treatment results in CSI patients concerning recurrence rate and overall survival in non-seminoma (NS) and pure seminoma (SE) resulting from surveillance in comparison to adjuvant strategies. Methods/systematic review: We performed a systematic literature review confining the search to most recent studies published 2010–2021 that reported direct comparisons of surveillance to adjuvant management. We searched Medline and the Cochrane Library with additional hand-searching of reference lists to identify relevant studies. Data extraction and quality assessment of included studies were performed with stratification for histology (NS vs. SE) and treatment modalities. The results were tabulated and evaluated with descriptive statistical methods. Results: Thirty-four studies met the inclusion criteria. In NS patients relapse rates were 12 to 37%, 0 to 10%, and 0 to 11.8% for surveillance, chemotherapy and for retroperitoneal lymph node dissection (RPLND) while overall survival rates were 90.7−100%, 91.7−100%, and 97−99.1%, respectively. In SE CSI, relapse rates were 0−22.3%, 0−5%, and 0−12.5% for surveillance, radiotherapy, chemotherapy, while overall survival rates were 84.1−98.7%, 83.5−100%, and 92.3−100%, respectively. Conclusion: In both histologic subgroups, active surveillance offers almost identical overall survival as adjuvant management strategies, however, at the expense of higher relapse rates. Each of the management strategies in CSI GCT patients have specific merits and shared-decision-making is advised to tailor treatment.
Author(s): Ruf CG, Schmidt S, Kliesch S, Oing C, Pfister D, Busch J, Heinzelbecker J, Winter C, Zengerling F, Albers P, Oechsle K, Krege S, Lackner J, Dieckmann K-P
Publication type: Article
Publication status: Published
Journal: World Journal of Urology
Year: 2022
Volume: 40
Issue: 12
Pages: 2889-2900
Print publication date: 01/12/2022
Online publication date: 15/09/2022
Acceptance date: 23/07/2022
Date deposited: 26/07/2024
ISSN (print): 0724-4983
ISSN (electronic): 1433-8726
Publisher: Springer Science and Business Media Deutschland GmbH
URL: https://doi.org/10.1007/s00345-022-04145-6
DOI: 10.1007/s00345-022-04145-6
PubMed id: 36107211
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