← Back to The Absolute EffectGerm Cell Tumours · Medical · Stage I Nonseminoma · Surveillance / Risk Stratification · 2026-09-18
Daugaard stage-I NSGCT surveillance cohort
After orchiectomy alone, what is the relapse risk during surveillance for stage I nonseminoma, and which pathological factors identify higher-risk patients?
Population
1,226 patients with stage I nonseminoma, including patients with vascular invasion, managed in a surveillance programme from 1984–2007.
Intervention
Active surveillance after orchiectomy.
Comparator
No randomized treatment comparator; relapse risk was stratified by pathological risk factors.
Sample size / primary endpoint
1,226 patients; Relapse during surveillance
Absolute Effect
Primary efficacy result
5-year relapse after orchiectomy alone: 30.6%; approximately 50% with combined high-risk pathological factors vs 12% without risk factors
Long-term population-based surveillance cohort.
Overall survival was excellent with appropriate salvage treatment; the study's key contribution is relapse risk rather than comparative OS.
Relapse-free survival is represented through cumulative relapse rates rather than randomized PFS.
NNT / NNH
NNT: not applicable; observational risk-stratification cohort without randomized intervention.
NNH: not applicable; surveillance itself was not randomized against a treatment arm.
Treatment burden and toxicity
No treatment toxicity is generated by the surveillance strategy itself, although relapse can require subsequent chemotherapy or surgery.
Quality of life: Avoiding immediate adjuvant therapy can reduce overtreatment in patients who would otherwise remain disease-free.
Subgroups / clinically important modifiers
Vascular invasion, embryonal carcinoma and rete-testis invasion identified a subgroup with approximately 50% relapse risk; without these factors relapse risk was about 12%.
Limitations and maturity
Historical cohort spanning multiple decades; treatment and surveillance protocols evolved. Risk-factor combinations are prognostic, not randomized predictive biomarkers.
Clinical interpretation
Surveillance is a viable strategy after orchiectomy for stage I nonseminoma, but pathological risk factors can identify patients whose relapse risk is high enough to justify discussing adjuvant therapy.
This study supplies the natural-history baseline needed to interpret later randomized and prospective stage-I NSGCT treatment trials; without the untreated relapse risk, absolute treatment benefit cannot be understood.
Primary / authoritative sources
Current-practice context · reviewed 14 October 2026
Surveillance after orchiectomy remains an important option for compliant patients with clinical stage I nonseminoma, because many patients are cured by orchiectomy alone and relapses are usually salvageable. Vascular invasion and other pathological risk factors should inform discussion of surveillance versus one-cycle adjuvant BEP, not be treated as randomized predictors of treatment benefit. The choice must account for follow-up reliability, fertility priorities, chemotherapy late effects and patient preference.
EAU testicular-cancer guidance ↗ · Daugaard surveillance cohort ↗