Clinical outcomes of late relapse in stage I seminoma.
Bibliographic record
Abstract
4537 Background: This study aimed to identify characteristics associated with late relapse (LR) in stage I seminoma and determine clinical outcomes according to timing of relapse. Methods: Between 1981 and 2011, 949 stage I seminoma patients were managed at our institution. Of these, 254 were treated with adjuvant radiotherapy (aRT) and 695 were managed by active surveillance (AS). LR was defined as tumor recurrence more than 2 years after orchiectomy. Treatment at relapse was dependent on initial treatment and disease extent at relapse. Progression free survival (PFS) from end of treatment of first relapse and overall survival (OS) were calculated. Results: At median follow-up of 10.9 years, 129 patients relapsed at median of 12 months; 14 after aRT and 115 on AS. There was no significant difference between the proportion of patients with LR for aRT (3/14; 25%) vs. AS (29/115; 21%) with no specific clinicopathological features were associated with LR. Paraaortic node(s) was the most common relapse site in AS patients either in LR (n = 28, 97%; median size: 2.1 cm) or early relapse (n = 79, 92%; median size: 2 cm), whereas in aRT patients; all LR were in mediastinum, and early relapse was inguinal (n = 4), scrotal (n = 3) and distant (n = 4). Most LR occurred between 2-3 years (n = 14, 44%; 13 of them were AS patients), and 8 of 9 patients who had LR beyond 5 years were on AS. Treatment of first relapse for aRT group consisted of chemotherapy (n = 10), RT (n = 3) and surgery (n = 1); and for the AS group: RT (n = 87), chemotherapy (n = 26) and surgery (n = 2).Only 1 aRT patient developed second relapse. Nine AS patients had second relapse (7 after RT and 2 after chemotherapy) at a median (range) time of 13 (2–48) months. Second relapse was predominantly distant (9/10), however all were successfully salvaged with chemotherapy. The 5-year PFS from end of treatment of first relapse for the whole, aRT and AS groups were similar, 93%. Among AS group, there was no significant difference between early and late relapse in 5-year PFS (91% vs 100%, p= 0.1) or 10-year OS (96%, for both). Conclusions: In stage I seminoma, the extent and pattern of LR is similar to that for early relapse. For AS patients, selective use of RT/chemotherapy for relapse results in excellent outcomes regardless of timing of relapse.
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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".