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Initial surveillance in men with marker negative clinical stage IIA non-seminomatous germ cell tumours
Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institutet, Stockholm, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden.
Department of Oncology, Oslo University Hospital, Oslo, Norway.
Department of Urology, Haukeland University Hospital, Bergen, Norway.
Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenborg, Sweden.
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2024 (Engelska)Ingår i: BJU International, ISSN 1464-4096, E-ISSN 1464-410XArtikel i tidskrift (Refereegranskat) Epub ahead of print
Abstract [en]

Objectives: To assess whether extended surveillance with repeated computed tomography (CT) scans for patients with clinical stage IIA (CS IIA; <2 cm abdominal node involvement) and negative markers (Mk−) non-seminomatous germ cell tumours (NSGCTs) can identify those with true CS I. To assess the rate of benign lymph nodes, teratoma, and viable cancer in retroperitoneal lymph node dissection (RPLND) histopathology for patients with CS IIA Mk− NSGCT.

Patients and methods: Observational prospective population-based study of patients diagnosed 2008–2019 with CS IIA Mk− NSGCT in the Swedish and Norwegian Testicular Cancer Group (SWENOTECA) registry. Patients were managed with surveillance, with CT scans, and tumour markers every sixth week for a maximum of 18 weeks. Patients with radiological regression were treated as CS I, if progression with chemotherapy, and remaining CS IIA Mk− disease with RPLND. The end-point was the number and percentage of patients down-staged to CS I on surveillance and rate of RPLND histopathology presented as benign, teratoma, or viable cancer.

Results: Overall, 126 patients with CS IIA Mk− NSGCT were included but 41 received therapy upfront. After surveillance for a median (range) of 6 (6–18) weeks, 23/85 (27%) patients were in true CS I and four (5%) progressed. Of the remaining 58 patients with lasting CS IIA Mk− NSGCT, 16 received chemotherapy and 42 underwent RPLND. The RPLND histopathology revealed benign lymph nodes in 11 (26%), teratoma in two (6%), and viable cancer in 29 (70%) patients.

Conclusions: Surveillance with repeated CT scans can identify patients in true CS I, thus avoiding overtreatment. The RPLND histopathology in patients with CS IIA Mk− NSGCT had a high rate of cancer and a low rate of teratoma.

Ort, förlag, år, upplaga, sidor
John Wiley & Sons, 2024.
Nyckelord [en]
chemotherapy, germ cell tumour, non-seminoma, retroperitoneal lymph node dissection, testicular cancer
Nationell ämneskategori
Cancer och onkologi
Identifikatorer
URN: urn:nbn:se:umu:diva-220877DOI: 10.1111/bju.16289ISI: 001154822400001PubMedID: 38293778Scopus ID: 2-s2.0-85183908049OAI: oai:DiVA.org:umu-220877DiVA, id: diva2:1838445
Tillgänglig från: 2024-02-16 Skapad: 2024-02-16 Senast uppdaterad: 2024-02-16

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