Non-risk-adapted Surveillance for Stage I Testicular Cancer: Critical Review and Summary

作者：Pierorazio Phillip Martin^*; Albers Peter; Black Peter C; Tandstad Torgrim; Heidenreich Axel; Nicolai Nicola; Nichols Craig

来源：European Urology, 2018, 73(6): 899-907.

DOI：10.1016/j.eururo.2017.12.030

• Testicular cancer
• Germ cell tumor
• Active surveillance

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. management strategy.

• 出版日期2018-6