Relapse detection in the Danish surveillance program of patients with clinical stage I seminoma: a nationwide study
Background and purpose: Active surveillance is a recommended management strategy for patients with clinical stage I (CSI) seminoma. This study aims to identify patterns of relapse detection methods in an unselected population-based cohort of CSI patients and provide evidence for a risk-adapted follo...
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| Language: | English |
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Medical Journals Sweden
2025-01-01
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| Series: | Acta Oncologica |
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| Online Access: | https://medicaljournalssweden.se/actaoncologica/article/view/42281 |
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| author | Niklas B. Lindahl Jakob Lauritsen Thomas Wagner Gedske Daugaard Mikkel Bandak |
| author_facet | Niklas B. Lindahl Jakob Lauritsen Thomas Wagner Gedske Daugaard Mikkel Bandak |
| author_sort | Niklas B. Lindahl |
| collection | DOAJ |
| description | Background and purpose: Active surveillance is a recommended management strategy for patients with clinical stage I (CSI) seminoma. This study aims to identify patterns of relapse detection methods in an unselected population-based cohort of CSI patients and provide evidence for a risk-adapted follow-up program.
Patients/materials and methods: A total of 924 patients with CSI seminoma were identified in the prospective Danish Testicular Cancer database. Retrospectively collected clinical data were used for descriptive analyses of patterns in detection methods. Additionally, we explored a risk-adapted surveillance approach based on recently identified risk factors for relapse, classifying patients into low- and non-low-risk groups.
Results: At 60 months, the 5-year cumulative relapse risk was 16%, with 146 relapses during surveillance. Relapses were detected by imaging alone in 71% of cases, imaging combined with elevated serum tumor markers (STMs) in 18%, isolated elevation of STMs in 8%, and by self-referral due to symptoms in 3%. No relapses were detected by abnormal findings at a physical examination. In total, 134 (92%) relapses were localized to retroperitoneal lymph nodes, primarily without additional spread. The 5-year relapse risk in patients with low risk of relapse was 9% compared to 28% in patients in the non-low-risk group.
Interpretation: This study highlights that the surveillance program can detect relapses at an early stage. Reduction of visits and omission of routine physical examinations can safely be considered for patients with a low risk of relapse, while further research is needed to optimize follow-up and treatment for patients at higher risk of relapse.
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| format | Article |
| id | doaj-art-f2eee3e05ad341c7b11088b1a9b25e49 |
| institution | Kabale University |
| issn | 1651-226X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Medical Journals Sweden |
| record_format | Article |
| series | Acta Oncologica |
| spelling | doaj-art-f2eee3e05ad341c7b11088b1a9b25e492025-01-31T11:38:18ZengMedical Journals SwedenActa Oncologica1651-226X2025-01-016410.2340/1651-226X.2025.42281Relapse detection in the Danish surveillance program of patients with clinical stage I seminoma: a nationwide studyNiklas B. Lindahl0https://orcid.org/0009-0002-9524-8131Jakob Lauritsen1https://orcid.org/0000-0002-9985-174XThomas Wagner2https://orcid.org/0000-0002-0256-0074Gedske Daugaard3https://orcid.org/0000-0002-9618-9180Mikkel Bandak4https://orcid.org/0000-0003-3475-9675Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark1. Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Pathology, Herlev and Gentofte Hospital, Copenhagen University Hospital, DenmarkDepartment of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkBackground and purpose: Active surveillance is a recommended management strategy for patients with clinical stage I (CSI) seminoma. This study aims to identify patterns of relapse detection methods in an unselected population-based cohort of CSI patients and provide evidence for a risk-adapted follow-up program. Patients/materials and methods: A total of 924 patients with CSI seminoma were identified in the prospective Danish Testicular Cancer database. Retrospectively collected clinical data were used for descriptive analyses of patterns in detection methods. Additionally, we explored a risk-adapted surveillance approach based on recently identified risk factors for relapse, classifying patients into low- and non-low-risk groups. Results: At 60 months, the 5-year cumulative relapse risk was 16%, with 146 relapses during surveillance. Relapses were detected by imaging alone in 71% of cases, imaging combined with elevated serum tumor markers (STMs) in 18%, isolated elevation of STMs in 8%, and by self-referral due to symptoms in 3%. No relapses were detected by abnormal findings at a physical examination. In total, 134 (92%) relapses were localized to retroperitoneal lymph nodes, primarily without additional spread. The 5-year relapse risk in patients with low risk of relapse was 9% compared to 28% in patients in the non-low-risk group. Interpretation: This study highlights that the surveillance program can detect relapses at an early stage. Reduction of visits and omission of routine physical examinations can safely be considered for patients with a low risk of relapse, while further research is needed to optimize follow-up and treatment for patients at higher risk of relapse. https://medicaljournalssweden.se/actaoncologica/article/view/42281Testicular cancergerm cell cancerseminomaserum tumor markersactive surveillancefollow-up |
| spellingShingle | Niklas B. Lindahl Jakob Lauritsen Thomas Wagner Gedske Daugaard Mikkel Bandak Relapse detection in the Danish surveillance program of patients with clinical stage I seminoma: a nationwide study Acta Oncologica Testicular cancer germ cell cancer seminoma serum tumor markers active surveillance follow-up |
| title | Relapse detection in the Danish surveillance program of patients with clinical stage I seminoma: a nationwide study |
| title_full | Relapse detection in the Danish surveillance program of patients with clinical stage I seminoma: a nationwide study |
| title_fullStr | Relapse detection in the Danish surveillance program of patients with clinical stage I seminoma: a nationwide study |
| title_full_unstemmed | Relapse detection in the Danish surveillance program of patients with clinical stage I seminoma: a nationwide study |
| title_short | Relapse detection in the Danish surveillance program of patients with clinical stage I seminoma: a nationwide study |
| title_sort | relapse detection in the danish surveillance program of patients with clinical stage i seminoma a nationwide study |
| topic | Testicular cancer germ cell cancer seminoma serum tumor markers active surveillance follow-up |
| url | https://medicaljournalssweden.se/actaoncologica/article/view/42281 |
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