A comprehensive systematic review of testicular germ cell tumor surveillance

• Published in: Critical reviews in oncology/hematology 2007-12, Vol.64 (3), p.182-197
• Main Authors: Groll, R.J, Warde, P, Jewett, M.A.S
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Costs and Cost Analysis; Follow-Up Studies; Gynecology. Andrology. Obstetrics; Hematologic and hematopoietic diseases; Hematology, Oncology and Palliative Medicine; Humans; Male; Male genital diseases; Medical sciences; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - pathology; Neoplasms, Germ Cell and Embryonal - diagnosis; Neoplasms, Germ Cell and Embryonal - economics; Neoplasms, Germ Cell and Embryonal - pathology; Neoplasms, Germ Cell and Embryonal - therapy; Prognosis; Review; Seminoma - diagnosis; Seminoma - economics; Seminoma - mortality; Seminoma - pathology; Surveillance; Systematic; Testicular cancer; Testicular Neoplasms - diagnosis; Testicular Neoplasms - economics; Testicular Neoplasms - pathology; Testicular Neoplasms - therapy; Treatment Outcome; Tumors
• ISSN: 1040-8428; 1879-0461
• DOI: 10.1016/j.critrevonc.2007.04.014

Abstract Background Testicular cancer is the most common malignancy in men aged 15–34, and its incidence has been increasing over the past half-century. Survival for stage I testis cancer approaches 100% regardless of management strategy which is often dictated by other factors such as perceived morbidity. Advances in treatment have attempted to decrease morbidity and surveillance is thought to achieve this goal. Methods An English language literature search of MEDLINE from 1966 to December 2005 and CINAHL from 1982 to December 2005 was conducted using a broad search strategy. Comparative and descriptive original articles on outcomes of seminoma or NSGCT surveillance would be deemed eligible and review articles containing no original data were omitted. One hundred and thirty-eight articles were selected for formal review, during which a database was compiled that documented the first author, publication year, tumor histologic type, study purpose or topic(s), methodology, sample size, median follow-up, and relevant results. Results Most evidence for the efficacy of surveillance is from descriptive series or non-experimental comparative studies. Relapse occurs in approximately 28% and 17% of surveillance patients in NSGCT and seminoma, respectively, and cause-specific survival is approximately 98% and 100%, respectively. Compliance with surveillance ranges from poor to adequate, however there is no evidence that compliance impacts clinical outcome. Cost analyses have yielded inconsistent results when comparing treatment modalities. There is scant literature on quality of life and psychosocial issues and results are inconsistent. Active surveillance appears to be appropriate and perhaps optimal first line management of clinical stage I seminoma and non-seminomatous germ cell tumors. Further quantitative and qualitative research is warranted to deepen understanding of these issues that may impact treatment decision-making.