Commentary on 'Patterns of care in the management of seminoma stage I: Results from a European survey.' Vossen CY, Horwich A, Daugaard G, Vossen CY, Horwich A, Daugaard G, van Poppel H, Osanto S, Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands. BJU Int 2012;110:524

摘要

Study Type - Therapy (practise pattern survey). Level of Evidence 3b. What's known on the subject? and What does the study add? The uncertainties about differences in relapse and rates of other late events such as second malignancy and cardiovascular events for the three post-orchidectomy strategies in seminoma stage I patients has led to debates about whether the three strategies are equally effective and safe. The differences in interpretation of the data as well as the debates are likely to result in differences in treatment after orchidectomy in seminoma stage I patient management. Current care patterns after orchidectomy are, however, unknown. We assessed patterns of care for seminoma stage I patients after orchidectomy by distributing a survey among doctors treating such patients across Europe. The 969 respondents showed large differences in care strategies between specialties and countries that indicate the need for research into long-term relapse rates and long-term adverse effects to standardize and optimize care for seminoma stage I patients. Objective: To assess precise patterns of care after orchidectomy in Europe for stage I seminoma patients, we aimed to perform a survey among doctors in the various European countries. Patients and methods: We distributed a survey in 2009 and 2010 among American Society of Clinical Oncology and European Association of Urology members. Results: In total, 969 questionnaires were included in the analysis. More than half of the 969 physicians (58%) currently offer only one post-surgical treatment: 18% only surveillance, 19% only radiotherapy and 21% only chemotherapy. Thirteen percent of the 969 physicians currently offer all three strategies, 25% offer surveillance and adjuvant radiotherapy or chemotherapy, and 5% offer either adjuvant radiotherapy or chemotherapy without surveillance. ? We found large differences in care patterns between specialties and countries. Even within countries, care after orchidectomy was not standardized. ? Before 2005, 73% of the physicians offered only one treatment and of those 51% gave adjuvant radiotherapy. Conclusions: Large differences in pattern of care after orchidectomy for stage I seminoma patients exist between specialties and countries within Europe. ? More information on long-term relapse rates and long-term adverse effects of the three strategies is needed to standardize and optimize care after orchidectomy.