Presentation Authors: Jason Frankel*, Fernando Caumont, Adam Omidpanah, Christopher Porter, John Paul Flores, Seattle, WA
Introduction: Active surveillance is the preferred treatment strategy for patients with stage 1A and 1B seminoma as reflected in the National Comprehensive Cancer Network (NCCN) guidelines. However, many patients continue to receive adjuvant chemotherapy or radiation for these cancers. In this study, we aimed to describe trends in adjuvant therapy for stage 1 seminoma using the National Cancer Database (NCDB).
Methods: The NCDB was queried for all patients diagnosed with stage 1A or 1B seminoma between 2004 and 2015. Staging was determined using the American Joint Committee on Cancer guidelines. Active surveillance was defined as no treatment with chemotherapy or radiation within 90 days of diagnosis. Patients receiving retroperitoneal lymph node dissection (RPLND) were excluded from the analysis as NCDB does not record dates associated with RPLND, so salvage or primary surgery cannot be determined. Proportions of cancer patients utilizing active surveillance were summarized annually. Trend was assessed using the Cochran-Armitage test and additive risk models.
Results: 17,619 patients with stage 1, 1A or 1B seminomas after orchiectomy were identified over the course of the study period. Of these, 8,462 (48.0%) patients began adjuvant chemotherapy or radiation within 90 days. 6,304 (35.8%) underwent radiation and 2,132 (12.1%) chemotherapy, 4 used both and 22 used other. In 2004, 488 (31.6%) of patients were actively surveilled. Since 2004, rates of active surveillance increased by an average of 4.2% per year (95% CI: 4.0%-4.4%; p-trend < 0.001). By 2015, the most recent year of available data, 1,056 (78.1%) of cases were actively surveilled (Figure 1).
Conclusions: In the time frame studied, 48% of patients underwent adjuvant treatment for Stage 1A and 1B seminoma in this national, hospital-based cohort. A major shift from utilization of adjuvant treatment to active surveillance is observed over time. However, many patients still receive adjuvant treatment and risk related toxicities. Continued education and guideline dissemination may improve surveillance rates.