Context

Cancer-specific survival for men with clinical stage I testicular cancer (CSITC) is uniformly excellent. Non–risk-adapted active surveillance (NRAS) is a management strategy for CSITC to minimize overtreatment and avoid possible long-term side effects of adjuvant therapy.

Objective

To review the evidence regarding oncologic outcomes for men with CSITC undergoing NRAS and discuss ongoing controversies in the management of CSITC.

Evidence acquisition

MEDLINE/PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from January 1, 1987 through January 1, 2017.

Evidence synthesis

A total of 68 studies were included in the critical review. The rationale for NRAS, oncologic outcomes, surveillance protocols, and comparative efficacy of risk-adjusted active surveillance (AS) were reported with strength of evidence and risk of bias evaluated. Cancer-specific survival approaches 100% for men with CSITC undergoing NRAS. Active treatment is limited to 20–30% of patients who will recur; these patients will require salvage chemotherapy and possible retroperitoneal lymph node dissection. Existing AS protocols include imaging and laboratory evaluations that are initially intensive but less frequent with increasing follow-up.

Conclusions

NRAS is an attractive management option for men with CSITC, which maintains outstanding long-term cancer cure while sparing most patients treatment by avoiding prophylactic chemotherapy, radiation, or surgery.

Patient summary

Men with clinically localized (stage I) testicular cancer have an excellent prognosis, regardless of management. Non–risk-adapted active surveillance is an attractive management option where only patients destined to relapse will receive any treatment following orchiectomy. However, individual patient preferences should be discussed in selecting a management strategy.

中文翻译：

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I期睾丸癌的非风险适应性监测：关键性回顾和总结

语境

对于具有I期临床睾丸癌（CSITC）的男性，其癌症特异性生存率始终很高。非风险适应性主动监测（NRAS）是CSITC的一种管理策略，可最大程度地减少过度治疗并避免辅助治疗的可能的长期副作用。

客观的

审查有关接受NRAS治疗的CSITC男性肿瘤结局的证据，并讨论CSITC管理中正在进行的争议。

取证

检索1987年1月1日至2017年1月1日的MEDLINE / PubMed，Embase和Cochrane对照试验中央注册簿。

证据综合

共有68项研究纳入了关键评价。报告了NRAS的基本原理，肿瘤学结局，监测方案以及风险调整后的主动监测（AS）的相对疗效，并提供了证据强度和偏倚风险评估。对于接受NRAS治疗的CSITC男性，癌症特异性生存率接近100％。主动治疗仅限于将复发的患者的20％至30％；这些患者将需要挽救性化疗并可能进行腹膜后淋巴结清扫术。现有的AS协议包括成像和实验室评估，这些评估最初是密集的，但随着随访的增加而降低了频率。

结论

对于CSITC的男性，NRAS是一种有吸引力的管理选择，它可以保持出色的长期癌症治愈率，同时通过避免预防性化学疗法，放射线或手术来为大多数患者提供治疗。

病人总结

患有临床局限性（I期）睾丸癌的男性患者，无论治疗如何，均具有良好的预后。非风险适应性主动监视是一种有吸引力的管理选择，其中，只有要复发的患者才能接受睾丸切除术后的任何治疗。但是，在选择管理策略时应讨论患者的个人偏好。