Description

Warde et al identified risk factors for relapse in a patient with Stage I seminoma managed by surveillance alone. This can help identify which patients may require additional therapy and which can avoid its long term complications. The authors are from the University of Toronto, University of Copenhagen, Aarhus University Hospital, Royal Marsden Hospital (Surrey) and St. Bartholomew's Hospital (London).


 

Patient selection: pure seminoma, Stage I

 

Parameters identified on multivariate analysis:

(1) size of the primary tumor

(2) invasion of the rete testis

Parameter

Finding

Points

size of primary tumor

<= 4.0 cm

0

 

> 4.0 cm

1

invasion into rete testis

absent

0

 

present

1

 

number of risk factors for relapse =

= SUM(points for both parameters)

 

Interpretation:

• minimum number of risk factors: 0

• maximum number of risk factors: 2

• The risk of relapse is greater with the higher the number of risk factors.

• A patient with risk of relapse should be considered for additional therapy.

 

Number of Risk Factors

10 Year Relapse Free

0

87%

1

82%

2

56%

estimated from Figure 4, page 4450.

 

Additional risk factors:

(1) invasion into small blood vessels

(2) age <= 30 years of age

 


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