{Reference Type}: Journal Article
{Title}: A Risk-Adapted Approach to Patients with Stage I Seminoma according to the Status of Rete Testis: The Fourth Spanish Germ Cell Cancer Group Study.
{Author}: Aparicio J;Sánchez-Muñoz A;Gumà J;Domenech M;Meana JA;García-Sánchez J;Bastús R;Gironés R;González-Billalabeitia E;Sagastibelza N;Ochenduszko S;Sánchez A;Terrasa J;Germà-Lluch JR;García Del Muro X; ;
{Journal}: Oncology
{Volume}: 95
{Issue}: 1
{Year}: 2018
{Factor}: 3.734
{DOI}: 10.1159/000487438
{Abstract}: <B>OBJECTIVE: </B>The aim of this study was to assess a risk-adapted strategy for stage I seminoma guided by the presence of rete testis invasion.<BR><B>METHODS: </B>Between January 2013 and December 2015, a total of 135 consecutive patients with stage I seminoma from 18 Spanish tertiary hospitals were included in a prospective multicenter study. Median patient age was 38 years (range 22-60). Preoperative beta-human chorionic gonadotropin was elevated in 9.6% of patients. Rete testis invasion was present in 47.4% of patients. After orchiectomy, subjects with rete testis invasion were treated with 2 courses of adjuvant carboplatin (area under the curve of 7, with 21-day interval). Those without this risk factor were managed by surveillance. Disease-free survival (DFS) and overall survival (OS) were estimated with the Kaplan-Meier method.<BR><B>RESULTS: </B>After a median follow-up time of 33 months, only 6 relapses were recorded (5 on surveillance, 1 after carboplatin). These cases were rescued with BEP or EP chemotherapy, and all 135 patients are currently disease free without sequelae. Three-year DFS was 92.0 and 98.2% for patients on surveillance and after carboplatin, respectively. Three-year OS was 100%.<BR><B>CONCLUSIONS: </B>A risk-adapted approach based on rete testis invasion as a single risk factor is feasible and yielded an excellent outcome with a 3-year DFS of 94.9%.