BACKGROUND: Surveillance after orchiectomy alone has become popular in the management of clinical stage I nonseminomatous germ cell testicular tumors (CSI NSGCTT). Efforts to identify patients at high risk of disease progression led to a search for risk factors in CSI NSGCTT. The aim of this study was to analyze a 25-year single-center experience with risk-adapted therapeutic approaches-active surveillance (AS) versus adjuvant chemotherapy (ACT). PATIENTS AND METHODS: From January 1992 to January 2017, a total of 485 patients with CSI NSGCTT were stratified into the AS group (low-risk patients) and the ACT group (high-risk patients). Differences between relapse rates and overall survival rates in these groups were statistically analyzed. RESULTS: In the AS group, relapse occurred in 52 (17.3%) of 301 patients with a median follow-up of 7.2 months (range, 2-86 months). Six (2.0%) patients of this group died, with a median follow-up of 34.3 months (range, 11-102 months). In the ACT group, relapse occurred in 2 (1.1%) of 184 patients with a median follow-up of 56.2 months (range, 42-70 months). One (0.54%) patient died at 139.4 months following orchiectomy. The relapse rate for the AS group was 16.7 times higher than that for the ACT group. The groups did not differ in overall survival. The 3-year overall survival of all patients with CSI NSGCTT was 99.1% (95% confidence interval, 97.7%-99.7%). Three of a total of 7 deaths occurred thereafter. CONCLUSIONS: The policy of AS is recommended only in patients with low-risk CSI NSGCTT.

1st Department of Oncology Faculty of Medicine Comenius University St Elisabeth Cancer Institute Bratislava Slovak Republic

2nd Department of Radiology Faculty of Medicine Comenius University St Elisabeth Cancer Institute Bratislava Slovak Republic

Department of Nuclear Physics and Biophysics Faculty of Mathematics Physics and Informatics Comenius University Bratislava Slovak Republic

Institute for Hygiene and Epidemiology 1st Faculty of Medicine Charles University Prague Czech Republic

St Elizabeth University of Health and Social Sciences Bratislava Slovak Republic; Department of Epidemiology and Biostatistics Pharm In Ltd Bratislava Slovak Republic

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Single-course bleomycin, etoposide, and cisplatin (1xBEP) as adjuvant treatment in testicular nonseminoma clinical stage 1: outcome, safety, and risk factors for relapse in a population-based study