Modern guidelines improve late relapse rates, outcomes in testicular cancer
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CHICAGO — Centralized treatment and adherence to modern guidelines may account for “relatively low” rates of late relapse and improved long-term outcomes after treatment for testicular cancer, according to a speaker at ASCO.
“Late relapses as a unique entity with a worse prognosis compared [with] earlier relapses have been described for decades. However, published data reports a wide range, both in the prevalence and for prognosis,” Torgrim Tandstad, MD, PhD, from St. Olav’s University Hospital, Trondheim, Norway, said in a presentation.
Many of the often-referenced publications include older data and are from high-volume referral centers, “not necessarily giving a precise estimate on what we expect in a modern population-based setting,” Tandstad said.
In the presented population-based Norwegian study, frequency and survival rates of late relapses were assessed in 5,712 patients with testicular cancer — 2,978 with seminoma and 2,734 without — between 1980 and 2009 to determine whether the present understanding of late relapse as a clinical entity remains applicable.
To compare data on relapse rates more than 5 years after treatment over two time periods, one cohort contained 3,505 patients treated during or after 1995, and the other contained 2,207 patients treated through 1994.
Relapse was classified as “late” if more than 2 years elapsed from treatment to relapse, “very late” if more than 5 years elapsed, and “extremely late” if more than 10 years elapsed between the events.
The researchers found a low rate of late relapse (n = 109), very late relapse (n = 50) and extremely late relapse (n = 17). Eighty-six percent of relapses occurred within 5 years of follow-up, and only 14% occurred after 5 years.
Additionally, the 10-year cause-specific survival for the whole unselected relapse population was 81.4%, Tandstad said.
The researchers also observed a higher rate of late relapse in stage I disease managed with surveillance vs. adjuvant treatment (4% vs. 0.9%), Tandstad said.
“However, the survival in this group of patients is very good. And only eight deaths occurred in 61 patients with late relapse,” Tanstad said.
Moreover, improvement in the later cohort was found for the very late relapse rate in those with initial metastatic disease as well as survival of patients who relapsed following initial chemotherapy for metastatic disease. The 10-year overall survival rate of patients diagnosed between 1995 and 2009 was 60.9% compared with 34.6% of patients diagnosed between 1980 and 1994.
“We believe centralization of treatment, adherence to guidelines and continuous evaluation of results are key to these improved outcomes,” Tandstad said in the presentation. “The broad definition of late relapse should not be used to identify patients as a unique entity with the worst prognosis, as exemplified by the good prognosis of patients with initial metastatic disease relapsing 2 to 5 years following initial treatment.
“We believe there is a grave danger in using historical data to compare with current results as these data always will be outdated,” Tanstad added, “and we educate all centers treating testicular cancer to continuously monitor and report outcomes of patients treated.”
For more information:
Torgrim Tandstad, MD, PhD, can be reached at torgrim.tandstad@ntnu.no.
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Tandstad T, et al. Abstract LBA5008. Presented at: ASCO Annual Meeting; June 3-7, 2022; Chicago.
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