Clinical Utility of the AJCC 8th Edition pT1 Subclassification and Impact on Practice Patterns in Stage I Seminoma
dc.contributor.advisor | Bagrodia, Aditya | en |
dc.contributor.committeeMember | Woldu, Solomon L. | en |
dc.contributor.committeeMember | Meng, Xiaosong | en |
dc.creator | Badia, Rohit Reddy | en |
dc.creator.orcid | 0000-0001-6134-1237 | |
dc.date.accessioned | 2024-06-07T19:19:31Z | |
dc.date.available | 2024-06-07T19:19:31Z | |
dc.date.created | 2022-05 | |
dc.date.issued | 2022-05 | |
dc.date.submitted | May 2022 | |
dc.date.updated | 2024-06-07T19:19:31Z | |
dc.description | The general metadata -- e.g., title, author, abstract, subject headings, etc. -- is publicly available, but access to the submitted files is restricted to UT Southwestern campus access and/or authorized UT Southwestern users. | en |
dc.description.abstract | BACKGROUND: The American Joint Committee on Cancer 8th edition staging guidelines for testicular cancer established a 3 cm cutoff to subclassify stage T1 seminomas (<3 cm = pT1a and ≥3 cm = pT1b). The efficacy of this cutoff in predicting metastatic disease and impact on treatment patterns have not been studied. METHODS: We retrospectively reviewed patients with pT1 testicular seminoma in the National Cancer Database from 2004-2016. Receiver operating curves (ROC) were used to determine the efficacy of the 3 cm tumor cutoff in identifying metastatic disease, and multivariable regression was used to compute the effect of tumor size on the rate of adjuvant therapy among Stage I patients. RESULTS: 10,134 patients with pT1 seminoma were evaluated. The current size cutoff of 3 cm for subclassification did not exhibit high discrimination in identifying metastatic disease (area under ROC: 0.546). Surveillance has grown as the preferred treatment after orchiectomy - 32.1% in 2004 to 81.2% in 2015. However, the rate of adjuvant therapy for pT1, Stage I seminomas associated positively with tumor size even with adjustment for year of diagnosis. For tumors above 3 cm, the odds ratio stabilized around 1.9. By using the 3cm cutoff to guide adjuvant therapy, up to 85% of T1b patients may be overtreated. CONCLUSION: The 3 cm cutoff for subclassification of Stage I seminoma does not predict metastatic recurrence but is associated with increased receipt of adjuvant therapy. A 3 cm cutoff and the pT1a/b classification may therefore contribute to overtreatment in many young patients with a long life expectancy for whom minimizing adverse effects should be prioritized. | en |
dc.format.mimetype | application/pdf | en |
dc.identifier.oclc | 1438578620 | |
dc.identifier.uri | https://hdl.handle.net/2152.5/10328 | |
dc.language.iso | en | en |
dc.subject | Neoplasm Staging | en |
dc.subject | Retrospective Studies | en |
dc.subject | Seminoma | en |
dc.subject | Testicular Neoplasms | en |
dc.subject | Treatment Outcome | en |
dc.title | Clinical Utility of the AJCC 8th Edition pT1 Subclassification and Impact on Practice Patterns in Stage I Seminoma | en |
dc.type | Thesis | en |
dc.type.material | text | en |
local.embargo.lift | 2024-06-01 | |
local.embargo.terms | 2024-06-01 | |
thesis.degree.department | UT Southwestern Medical School | en |
thesis.degree.discipline | Research | en |
thesis.degree.grantor | UT Southwestern Medical Center | en |
thesis.degree.level | Doctoral | en |
thesis.degree.name | M.D. with Distinction | en |