Surveillance or Adjuvant Treatment With Chemotherapy or Radiotherapy in Stage I Seminoma: A Systematic Review and Meta-Analysis of 13 Studies

ObjectiveTesticular stage I seminoma has a remarkable cure rate with orchiectomy alone. The benefit of adjuvant therapy is questionable, and a direct comparison with active surveillance is lacking. We performed a meta-analysis to evaluate the benefit of adjuvant radiotherapy (RT) or chemotherapy (CT) compared with surveillance alone on relapse-free survival (RFS), overall survival (OS), and noncancer-related mortality in patients with stage I seminoma.MethodsWe performed a systematic search of PubMed, EMBASE, Web of Science, SCOPUS, and the Cochrane Register of Controlled Trials. Meta-analysis was performed using the fixed- or random-effects models. The primary endpoint was 5-year RFS, and secondary endpoints were 5-year OS and 5-year noncancer-related mortality, reported as odds ratios (ORs) and 95% confidence intervals (CIs).ResultsA total of 13 trials (11 retrospective and 2 prospective cohort series), including 12,075 patients with stage I seminoma, were analyzed. The relapse rates were 3.9% versus 14.8% in the adjuvant therapy and surveillance arms, respectively. Overall, adjuvant therapy significantly improved 5-year RFS (OR, 0.17; 95% CI, 0.1-0.29; P < .00001), but not 5-year OS (OR, 1.03; 95% CI, 0.46-2.28; P = .94). Mortality due to other causes was not significantly increased with CT or RT.ConclusionsAdjuvant RT and CT reduce recurrence risk by 80% of stage I seminoma. However, they do not increase OS or noncancer-related mortality. Both treatment options can be offered to patients with stage I seminoma, taking into consideration the side effects and high cure rate of testicular cancer at relapse.