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.

中文翻译：

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临床阶段IS睾丸癌的当代治疗模式和结果

背景

关于睾丸临床分期为IS半精原细胞瘤（SGCT）和非精原细胞生殖细胞瘤（NSGCT）的最佳治疗策略存在争议。

客观的

评估现代治疗方式和临床分期睾丸癌的结局。

设计，设置和参与者

利用美国国家癌症数据库（2004-2012），我们确定了1362例临床阶段为SGCT和NSGCT的睾丸患者，均接受了辅助治疗（AT）或观察治疗。

成果指标和统计分析

我们计算了年度变化百分比（APC）以评估治疗趋势。采用治疗加权比重（IPTW）调整后的Kaplan-Meier曲线的逆概率和Cox回归分析来比较AT组和观察组之间的总生存期（OS）。根据组织学类型对分析进行分层。

结果与局限性

总体而言，分别有SGCT和NSGCT的男性为581名（43％）和781名（57％）。在SGCT男性中，在研究期间，AT的使用减少（APC = –2.7，95％置信区间[CI]：– 4.4，–1.1，p  = 0.001）。AT组和观察组经5年IPTW调整的OS率分别为99％和97％（危险比= 0.36，95％CI：0.12，1.14，p  = 0.08）。在患有NSGCT的男性中，在研究期间AT的使用保持稳定（APC = + 0.8，95％CI：–0.7，+ 2.2，p  = 0.29）。AT组和观察组经5年IPTW调整的OS率分别为97％和95％（HR = 0.66，95％CI：0.27，1.61，p  = 0.36）。局限性包括缺乏完整的治疗细节和癌症特异性生存信息。

结论

随着时间的流逝，SGCT使用AT的趋势显着下降，而NSGCT则保持稳定。尽管如此，我们报告两种组织的5年OS率≥95％，使用AT并没有任何明显的益处。有必要做进一步的研究来证实这些发现。

病人总结

我们评估了IS期睾丸癌的治疗趋势和结局。我们发现精原细胞瘤的治疗随着时间的推移而变化，非精原细胞瘤的治疗保持稳定。与对于半裸细胞瘤和非半裸细胞瘤的生殖细胞肿瘤的观察相比，使用辅助治疗没有显着的生存获益。