{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T22:13:38Z","timestamp":1792016018477,"version":"4.4.0"},"reference-count":37,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCO"],"published-print":{"date-parts":[[2003,4,15]]},"abstract":"<jats:p> Purpose: To prospectively assess potential risk factors for relapse in clinical stage I nonseminomatous germ cell tumors of the testis (CS I NSGCT). <\/jats:p><jats:p> Patients and Methods: From September 1996 to May 2002, 200 patients with CS I NSGCT were prospectively assigned to retroperitoneal lymph node dissection (RPLND), and risk factor assessment was performed within a multicenter protocol. One hundred sixty-five patients had an adequate minimum follow-up of 12 months (mean, 34.5 months) or had pathologic stage II. <\/jats:p><jats:p> Results: Pathologic stage II disease was found in 27.9% of patients. Only 0.6% of patients relapsed in the retroperitoneum after confirmation of pathologic stage I disease. With reference pathology, vascular invasion (VI) was most predictive of stage in multifactorial analysis (accuracy, 65.1%). However, the positive predictive value (PPV) of VI to predict patients who have metastatic disease or relapse during follow-up was only 52.7%. With absent VI, low-risk patients had a negative predictive value (NPV) of 76.9%. With a combination of several risk factors, the PPV increased to 63.6% and the negative predictive value increased to 86.5%. <\/jats:p><jats:p> Conclusion: Even with an optimal combination of prognostic factors and reference pathology, more than one third of patients predicted to have pathologic stage II or relapse during follow-up will not harbor metastatic disease and, therefore, would be overtreated with adjuvant therapy. However, patients at low risk may be predicted at an 86.5% level, and thus, surveillance in highly compliant patients would be a valuable option. For high-risk patients, further reduction of adjuvant treatment is necessary. <\/jats:p>","DOI":"10.1200\/jco.2003.07.169","type":"journal-article","created":{"date-parts":[[2003,4,15]],"date-time":"2003-04-15T23:15:17Z","timestamp":1050448517000},"page":"1505-1512","source":"Crossref","is-referenced-by-count":266,"title":["Risk Factors for Relapse in Clinical Stage I Nonseminomatous Testicular Germ Cell Tumors: Results of the German Testicular Cancer Study Group Trial"],"prefix":"10.1200","volume":"21","author":[{"given":"Peter","family":"Albers","sequence":"first","affiliation":[{"name":"From the Departments of Urology and Medical Biometry, Bonn University, Bonn; Department of Urology, M\u00fcnster University, M\u00fcnster; Department of Urology and Institute of Pathology, Krankenhaus am Urban, Berlin; Department of Urology, Essen University, and Institute of Pathology Essen-Mitte, Essen; Department of Urology, Military Hospital, Ulm; Department of Urology, St\u00e4dtische Kliniken, Dortmund; Department of Urology, Marburg University, Marburg; Institute of Pathology, Leipzig University, Leipzig;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roswitha","family":"Siener","sequence":"additional","affiliation":[{"name":"From the Departments of Urology and Medical Biometry, Bonn University, Bonn; Department of Urology, M\u00fcnster University, M\u00fcnster; Department of Urology and Institute of Pathology, Krankenhaus am Urban, Berlin; Department of Urology, Essen University, and Institute of Pathology Essen-Mitte, Essen; Department of Urology, Military Hospital, Ulm; Department of Urology, St\u00e4dtische Kliniken, Dortmund; Department of Urology, Marburg University, Marburg; Institute of Pathology, Leipzig University, Leipzig;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine","family":"Kliesch","sequence":"additional","affiliation":[{"name":"From the Departments of Urology and Medical Biometry, Bonn University, Bonn; Department of Urology, M\u00fcnster University, M\u00fcnster; Department of Urology and Institute of Pathology, Krankenhaus am Urban, Berlin; Department of Urology, Essen University, and Institute of Pathology Essen-Mitte, Essen; Department of Urology, Military Hospital, Ulm; Department of Urology, St\u00e4dtische Kliniken, Dortmund; Department of Urology, Marburg University, Marburg; Institute of Pathology, Leipzig University, Leipzig;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lothar","family":"Weissbach","sequence":"additional","affiliation":[{"name":"From the Departments of Urology and Medical Biometry, Bonn University, Bonn; Department of Urology, M\u00fcnster University, M\u00fcnster; Department of Urology and Institute of Pathology, Krankenhaus am Urban, Berlin; Department of Urology, Essen University, and Institute of Pathology Essen-Mitte, Essen; Department of Urology, Military Hospital, Ulm; Department of Urology, St\u00e4dtische Kliniken, Dortmund; Department of Urology, Marburg University, Marburg; Institute of Pathology, Leipzig University, Leipzig;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Krege","sequence":"additional","affiliation":[{"name":"From the Departments of Urology and Medical Biometry, Bonn University, Bonn; Department of Urology, M\u00fcnster University, M\u00fcnster; Department of Urology and Institute of Pathology, Krankenhaus am Urban, Berlin; Department of Urology, Essen University, and Institute of Pathology Essen-Mitte, Essen; Department of Urology, Military Hospital, Ulm; Department of Urology, St\u00e4dtische Kliniken, Dortmund; Department of Urology, Marburg University, Marburg; Institute of Pathology, Leipzig University, Leipzig;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Sparwasser","sequence":"additional","affiliation":[{"name":"From the Departments of Urology and Medical Biometry, Bonn University, Bonn; Department of Urology, M\u00fcnster University, M\u00fcnster; Department of Urology and Institute of Pathology, Krankenhaus am Urban, Berlin; Department of Urology, Essen University, and Institute of Pathology Essen-Mitte, Essen; Department of Urology, Military Hospital, Ulm; Department of Urology, St\u00e4dtische Kliniken, Dortmund; Department of Urology, Marburg University, Marburg; Institute of Pathology, Leipzig University, Leipzig;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harald","family":"Schulze","sequence":"additional","affiliation":[{"name":"From the Departments of Urology and Medical Biometry, Bonn University, Bonn; Department of Urology, M\u00fcnster University, M\u00fcnster; Department of Urology and Institute of Pathology, Krankenhaus am Urban, Berlin; Department of Urology, Essen University, and Institute of Pathology Essen-Mitte, Essen; Department of Urology, Military Hospital, Ulm; Department of Urology, St\u00e4dtische Kliniken, Dortmund; Department of Urology, Marburg University, Marburg; Institute of Pathology, Leipzig University, Leipzig;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Heidenreich","sequence":"additional","affiliation":[{"name":"From the Departments of Urology and Medical Biometry, Bonn University, Bonn; Department of Urology, M\u00fcnster University, M\u00fcnster; Department of Urology and Institute of Pathology, Krankenhaus am Urban, Berlin; Department of Urology, Essen University, and Institute of Pathology Essen-Mitte, Essen; Department of Urology, Military Hospital, Ulm; Department of Urology, St\u00e4dtische Kliniken, Dortmund; Department of Urology, Marburg University, Marburg; Institute of Pathology, Leipzig University, Leipzig;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Werner","family":"de Riese","sequence":"additional","affiliation":[{"name":"From the Departments of Urology and Medical Biometry, Bonn University, Bonn; Department of Urology, M\u00fcnster University, M\u00fcnster; Department of Urology and Institute of Pathology, Krankenhaus am Urban, Berlin; Department of Urology, Essen University, and Institute of Pathology Essen-Mitte, Essen; Department of Urology, Military Hospital, Ulm; Department of Urology, St\u00e4dtische Kliniken, Dortmund; Department of Urology, Marburg University, Marburg; Institute of Pathology, Leipzig University, Leipzig;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Loy","sequence":"additional","affiliation":[{"name":"From the Departments of Urology and Medical Biometry, Bonn University, Bonn; Department of Urology, M\u00fcnster University, M\u00fcnster; Department of Urology and Institute of Pathology, Krankenhaus am Urban, Berlin; Department of Urology, Essen University, and Institute of Pathology Essen-Mitte, Essen; Department of Urology, Military Hospital, Ulm; Department of Urology, St\u00e4dtische Kliniken, Dortmund; Department of Urology, Marburg University, Marburg; Institute of Pathology, Leipzig University, Leipzig;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erhard","family":"Bierhoff","sequence":"additional","affiliation":[{"name":"From the Departments of Urology and Medical Biometry, Bonn University, Bonn; Department of Urology, M\u00fcnster University, M\u00fcnster; Department of Urology and Institute of Pathology, Krankenhaus am Urban, Berlin; Department of Urology, Essen University, and Institute of Pathology Essen-Mitte, Essen; Department of Urology, Military Hospital, Ulm; Department of Urology, St\u00e4dtische Kliniken, Dortmund; Department of Urology, Marburg University, Marburg; Institute of Pathology, Leipzig University, Leipzig;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Wittekind","sequence":"additional","affiliation":[{"name":"From the Departments of Urology and Medical Biometry, Bonn University, Bonn; Department of Urology, M\u00fcnster University, M\u00fcnster; Department of Urology and Institute of Pathology, Krankenhaus am Urban, Berlin; Department of Urology, Essen University, and Institute of Pathology Essen-Mitte, Essen; Department of Urology, Military Hospital, Ulm; Department of Urology, St\u00e4dtische Kliniken, Dortmund; Department of Urology, Marburg University, Marburg; Institute of Pathology, Leipzig University, Leipzig;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf","family":"Fimmers","sequence":"additional","affiliation":[{"name":"From the Departments of Urology and Medical Biometry, Bonn University, Bonn; Department of Urology, M\u00fcnster University, M\u00fcnster; Department of Urology and Institute of Pathology, Krankenhaus am Urban, Berlin; Department of Urology, Essen University, and Institute of Pathology Essen-Mitte, Essen; Department of Urology, Military Hospital, Ulm; Department of Urology, St\u00e4dtische Kliniken, Dortmund; Department of Urology, Marburg University, Marburg; Institute of Pathology, Leipzig University, Leipzig;..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Hartmann","sequence":"additional","affiliation":[{"name":"From the Departments of Urology and Medical Biometry, Bonn University, Bonn; Department of Urology, M\u00fcnster University, M\u00fcnster; Department of Urology and Institute of Pathology, Krankenhaus am Urban, Berlin; Department of Urology, Essen University, and Institute of Pathology Essen-Mitte, Essen; Department of Urology, Military Hospital, Ulm; Department of Urology, St\u00e4dtische Kliniken, Dortmund; Department of Urology, Marburg University, Marburg; Institute of Pathology, Leipzig University, Leipzig;..."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1097\/00005392-199501000-00030"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1992.10.11.1762"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1016\/S0090-4295(94)80056-1"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(01)61926-8"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19950201)75:3<844::AID-CNCR2820750316>3.0.CO;2-C"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19980901)83:5<1002::AID-CNCR27>3.0.CO;2-A"},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19970501)79:9<1710::AID-CNCR11>3.0.CO;2-0"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0215(19991210)83:6<828::AID-IJC23>3.0.CO;2-N"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.1159\/000464015"},{"key":"R10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.1993.tb15952.x"},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.2910570503"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(01)66454-1"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/93.11.824"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.1046\/j.1464-410x.1999.00072.x"},{"key":"R16","doi-asserted-by":"publisher","DOI":"10.1016\/S0090-4295(98)00576-7"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.1007\/s002590050547"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(01)66654-0"},{"key":"R19","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(01)66778-8"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.169.2.9242768"},{"key":"R21","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1986.4.7.1031"},{"key":"R22","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1990.8.3.509"},{"key":"R23","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.1992.tb15802.x"},{"key":"R24","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1992.10.1.69"},{"key":"R25","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1992.10.4.564"},{"key":"R26","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1995.13.5.1188"},{"key":"R27","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(01)63753-4"},{"key":"R28","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1996.14.2.441"},{"key":"R29","doi-asserted-by":"publisher","DOI":"10.1016\/S0959-8049(97)00041-5"},{"key":"R30","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(01)61615-X"},{"key":"R31","doi-asserted-by":"publisher","DOI":"10.1159\/000019656"},{"key":"R32","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2000.18.2.358"},{"key":"R33","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1993.11.9.1703"},{"key":"R34","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/89.19.1429"},{"key":"R35","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1998.16.10.3386"},{"key":"R36","unstructured":"Gerl A, Muhl-Bayer D, Hansmann G: The impact of chemotherapy on fasting plasma lipids in patients with germ cell tumors (GCT). Proc Am Soc Clin Oncol 18:1252a,1999,  (abstr)"},{"key":"R37","unstructured":"Meinardi MT, Gietema JA, van der Graaf WT, et al: Long-term vascular an metabolic sequelae of chemotherapy for metastatic testicular cancer: A comparison with long-term survivors of stage I disease. Proc Am Soc Clin Oncol 19:331a,2000,  (abstr 1302)"},{"key":"R38","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1996.14.4.1106"}],"container-title":["Journal of Clinical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/JCO.2003.07.169","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,25]],"date-time":"2022-05-25T20:36:46Z","timestamp":1653511006000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/JCO.2003.07.169"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2003,4,15]]},"references-count":37,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2003,4,15]]}},"alternative-id":["10.1200\/JCO.2003.07.169"],"URL":"https:\/\/doi.org\/10.1200\/jco.2003.07.169","relation":{},"ISSN":["0732-183X","1527-7755"],"issn-type":[{"value":"0732-183X","type":"print"},{"value":"1527-7755","type":"electronic"}],"subject":[],"published":{"date-parts":[[2003,4,15]]}}}