Should surveillance be considered the standard of care in stage I seminoma?
Bibliographic record
Abstract
4520 Background: Standard management for patients with stage I seminoma is adjuvant radiotherapy to the para-aortic ± ipsilateral pelvic lymph nodes. Over the past decade, surveillance has become more accepted but, despite the documented increased risk of second malignancies with adjuvant RT, it has not become widely accepted. This is partly because of the lack of long-term outcome data from surveillance series. We reviewed all patients with stage I disease over a 21 year period to compile information on outcomes in patients managed with these two approaches. Methods: 704 patients with stage I seminoma were seen at our institution between January 1981 and December 2002. Of those, 421 were placed on surveillance and 283 received adjuvant RT. Patient preference determined management approach. The median follow-up was 9.2 years (surveillance 8.1 years, adjuvant RT 10.2 years). Results: Of 421 patients on surveillance, 64 relapsed giving a 5 year relapse rate of 14.5%. The predominant site of relapse was the para-aortic lymph nodes alone in 57 patients (89%). Forty-eight (75%) of these relapses were were managed by RT, 14 with chemotherapy, and 2 with surgery. Of the 48 patients managed with RT for first relapse, 5 developed a second relapse and were salvaged with chemotherapy. The actuarial risk of requiring chemotherapy for treatment of first or second relapse on surveillance was 4.6% at 10 years. Of 283 patients who received adjuvant RT, 14 patients have relapsed giving a 5 year relapse rate of 4.9%. Of those, 10 (3.6%) were managed with chemotherapy, 3 with RT (inguinal recurrences), and 1 with surgery. The actuarial rate of requiring chemotherapy for treatment of relapse for patients managed with adjuvant RT was 3.9% at 10 years. In the whole series, only 1 patient has died of recurrent seminoma having relapsed on surveillance and failed salvage chemotherapy. Conclusions: Surveillance policy for stage I seminoma allows 85% of patients to avoid unnecessary RT. No increase in the number of patients who require chemotherapy has been observed. Given the documented risk of second malignancy associated with adjuvant RT, surveillance should be considered the standard of care with stage I seminoma. No significant financial relationships to disclose.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.024 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".