A Nationwide Cohort Study of Stage I Seminoma Patients Followed on a Surveillance Program
A Nationwide Cohort Study of Stage I Seminoma Patients Followed on a Surveillance Program
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DOI：
10.1016/j.eururo.2014.07.001
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发表时间：
2014-12-01
期刊：
影响因子：
23.4
通讯作者：
Daugaard, Gedske
中科院分区：
文献类型：
--
作者：
Mortensen, Mette Sakso;Lauritsen, Jakob;Daugaard, Gedske
背景：人们越来越担心 I 期精原细胞瘤辅助治疗后的后期影响，这使得监测成为一种有吸引力的替代方案。目的：评估全国性队列研究中的监测策略。设计、设置和参与者：一项回顾性、基于人群的研究，对象为 1984 年至 2008 年间诊断为 I 期精原细胞瘤的丹麦患者，并随访 5 年（n = 1954）。患者数据于 2012 年 11 月 30 日与国家登记处关联，以获得有关晚期复发、生命状态和死亡原因的信息。 结果测量和统计分析：描述了队列的疾病特异性生存 (DSS)、总生存、复发率、复发时间、复发检测和复发的预后因素。 Kaplan-Meier 方法用于确定生存概率。使用 Cox 比例风险模型对预后因素进行多变量分析。结果和局限性：中位随访时间为 15.1 年。总共有 369 名患者在中位 13.7 个月后复发。 15 年后的 DSS 为 99.3%。肿瘤大小是复发的重要因素。如果从分析中排除其他因素，则血管侵犯或附睾侵犯是显着的。局限性包括研究的回顾性和分析中缺失值的数量。结论：在世界上最大的 I 期精原细胞瘤患者研究中，我们发现监测是辅助治疗的安全替代方案。肿瘤大小以及附睾侵犯或血管侵犯是复发的重要因素。患者总结：在这项全国性研究中，我们观察了 I 期精原细胞瘤患者随访 5 年的结果。我们发现监测是辅助治疗的安全替代方案。 (C) 2014 年欧洲泌尿外科协会。由 Elsevier B.V. 出版。保留所有权利。
Background: Increasing concerns about late effects after adjuvant treatment for stage I seminoma have made surveillance an attractive alternative.Objective: To evaluate the surveillance strategy in a nationwide cohort study.Design, setting, and participants: A retrospective, population-based study of Danish patients diagnosed with stage I seminoma between 1984 and 2008 and followed for 5 yr (n = 1954). Patient data were linked with national registries on November 30, 2012, to obtain information on late relapse, vital status, and cause of death.Outcome measurements and statistical analysis: Disease-specific survival (DSS), overall survival, relapse rates, time to relapse, detection of relapse, and prognostic factors for relapse were described for the cohort. The Kaplan-Meier method was used to determine survival probabilities. A Cox proportional hazards model was used for multivariate analysis of prognostic factors.Results and limitations: Median follow-up time was 15.1 yr. In total, 369 patients relapsed after a median 13.7 mo. DSS after 15 yr was 99.3%. Tumor size was a significant factor for relapse. Either vascular invasion or invasion of epididymis was significant if the other factor was excluded from analysis. Limitations include the retrospective nature of the study and the number of missing values in analysis.Conclusions: In the world's largest study of stage I seminoma patients, we found surveillance to be a safe alternative to adjuvant therapies. Tumor size was a significant factor for relapse, together with either invasion of epididymis or vascular invasion.Patient summary: In this nationwide study, we looked at the outcomes of patients with stage I seminoma followed for 5 yr. We found that surveillance is a safe alternative to adjuvant treatment. (C) 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.