250P - Impact of adjuvant chemo(radio)therapy in stage I/II testicular seminoma

Background

Seminoma is the most common type of germ cell tumors representing 95% of all testicular neoplasm with mean age at diagnosis of 39 years. The standard treatment modality for stage I/II is orchidectomy with high cure rate.There is an active debate regarding the use of adjuvant therapy in stage I/II due to the high relapse rate and potential for overtreatment with serious systemic side effects. The aim of this study is to assess the impact of adjuvant treatment in stage I and stage II seminoma comparing the young and adolescents to older age groups.

Methods

Data of 11718 patients diagnosed with seminoma stage I/II were obtained from the Surveillance, Epidemiology, and End Results (SEER) program from 2000 to 2020. They were grouped by age at diagnosis into younger than 25 years (young age group), 25 to 49 years ( middle age group) and older than 50 years (old age group). SPSS 23 was used for data analysis, Kaplan-Meier curve and log rank test for survival analysis.

Results

Patients treated surgically with no systemic therapy had 5-year relative survival of 99,4% compared to adjuvant chemotherapy (98.3%) and adjuvant radiotherapy(100%), P<0.0001. The middle age group had quite similar 5-year relative survival compared to the young age group and the elderly (99.5%, 99.3% and 99%; P<0.0001). In the young age group the 5-year relative survival was 99.9% with orchidectomy, 97.4% with adjuvant chemotherapy and 100% with adjuvant radiotherapy (p <0.0001). In the middle age group, the 5-year relative survival was 99.2% with surgery with no systemic therapy, 98.4% with adjuvant chemotherapy and 99,9% with adjuvant radiotherapy (p <0.0001) while the old age group had 5-year relative survival of 98.9% for orchidectomy, 97.5% with adjuvant chemotherapy and 99.6% with adjuvant radiotherapy(p <0.0001).

Conclusions

The use of adjuvant chemotherapy and radiotherapy for clinical stage I and stage II testicular seminoma came statistically significant. However, adjuvant systemic therapy has very limited survival benefit compared to surgical management with no systemic therapy which discourage the use of adjuvant therapy for less systemic side effects with similar overall survival across different age groups.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.