Login to Access Video or Poster Abstract: MP76-08
Sources of Funding: None

Introduction

The preferred method of management for analytic stage I (CS1) Non Seminomatous Germ Cell Tumors (NSGCT) is active surveillance (AS). Approximately 30% of men with CS1 NSGCT are liable to relapse on AS. Pathological risk factors (PRF) may identify men at higher risk for relapse. Our aim was to evaluate trends in managing CS1 NSGCT and to examine the influence of PRF.

Methods

We used national cancer database (NCDB), 2004 to 2013; we examined AS, adjuvant Chemotherapy (ACT) and adjuvant retroperitoneal lymph node dissection (RPLND) using cross tabulation and trend analysis. We assessed PRF including, lympho-vascular invasion (LVI) and the presence of embryonal carcinoma (EC). We further examined the impact of CS1 sub-staging, IA, IB and IS, as defined by the TNM classification (UICC 2009 7th Ed.). Differences in overall survival (OS) were observed by treatment modality, based on log rank test.

Results

12,211 men were classified as CS1 NSGCT in NCDB; of these 2,484 men were LVI +ve, 4,686 were LVI -ve (5041 had missing LVI data); 2,624 men had EC. Trend analyses (Fig.1) showed a stable utilization of AS (p = 0.310), a rising preference for ACT (p <0.001) and a declining utilization of RPLND (p <0.001). Analysis of PRF showed 40% of LVI +ve men had ACT vs 18% of LVI -ve men, Fig 2. The presence of EC increased the chances for ACT (32% vs 22% in those with no EC). Analysis of CS1 sub-staging showed 37% of IB and 29% of IS had ACT vs only 15% of IA sub-group. RPLND use was not influenced by sub-staging or LVI status.

Conclusions

AS remains underutilized in CS1 NSGCT. We observed a slow but steady rise towards more ACT usage and a declining utilization of RPLND. Utilization of ACT was greatly influenced by PRF. We believe that PRF and subgrouping of CS1 may be influencing decision making for men with CS1 NSGCT disease that is amenable to AS.

Funding

None