No Role for Routine Chest Radiography in Stage I Seminoma Surveillance

作者：Tolan Shaun; Vesprini Danny; Jewett Michael A S; Warde Padraig R; O'Malley Martin; Panzarella Tony; Sturgeon Jeremy F G; Moore Malcolm; Tew George Betty; Gospodarowicz Mary K; Chung Peter W M^*

来源：European Urology, 2010, 57(3): 474-479.

DOI：10.1016/j.eururo.2009.06.029

• Stage I seminoma
• Surveillance
• Chest radiography

Background: After orchidectomy, the standard management options available for stage I seminoma are surveillance, adjuvant radiotherapy, or adjuvant chemotherapy. The optimal follow-up protocol for surveillance is yet to be determined but includes frequent chest radiography(CXR) and computed tomography(CT) scan of the abdomen and pelvis (CT-AP).
Objective: The purpose of this study was to identify the modality that first detected relapse and to assess the value of the CXR in this setting.
Design, setting, and participants: Five hundred twenty-seven patients with histologically confirmed stage I testicular seminoma were managed with surveillance at our institution between 1982 and 2005. Routine CXRs were performed with each CT-AP and were done every 4-6 mo for 7 yr and annually thereafter. The median follow-up was 72 mo (range: 1-193).
Measurements: Measurements included the 5-yr relapse rate, overall survival, and disease-free survival to determine the modality that first detected relapse disease.
Results and limitations: The 5-yr actuarial relapse rate for the 527 patients was 14%. The 5-yr disease-free survival and overall survival were 85.7% and 98.6%, respectively. Seventy-three patients (97.3%) had an abnormal CT-AP and a normal CXR at relapse. One patient (1.3%) had an abnormal CT-AP with pulmonary metastasis on CXR and CT chest scan, and one patient (1.3%) had a biopsy-proven inguinal node metastasis with a normal CXR. No patient had a normal CT-AP or physical examination with an abnormal CXR at relapse. This is a single-center retrospective study based on a relatively small number of relapses and may be subject to bias. Confirmation of these results from other studies would be useful for wider clinical applicability.
Conclusions: All except one relapse were detected by CT-AP with no relapses detected on CXR alone; therefore, CXR may be omitted as routine imaging in surveillance protocols.

• 出版日期2010-3