Study designs of evaluations included in the review
Full reports of any prospective design were eligible if they: (1) had clearly defined entry criteria; (2) provided a detailed description of the surveillance programme; (3) provided primary data on survival, relapse rate and/or salvage rate for relapsed patients; and (4) were published in English.
The review included one randomised trial and 12 case series. There were no randomised trials comparing surveillance schedules. The authors included one randomised trial comparing surveillance alone with radiotherapy after orchiectomy. Another randomised trial compared surveillance with adjuvant post-operative radiotherapy; however, the post-operative radiotherapy data were disregarded as this is not a standard treatment. It is unclear how the authors used the data from this study. Twelve case series were included where men received surveillance following orchiectomy. The surveillance periods ranged between 2 and 5 years (median follow-up: 21 to 136 months).
Specific interventions included in the review
All surveillance regimens for men with clinical stage I testicular cancer who received no adjuvant treatment were eligible for inclusion. The studies had to provide detailed descriptions of the surveillance programme.
The review assessed surveillance programmes for men with clinical stage I non-seminomatous germ cell tumours of the testis. One study compared surveillance alone with radiotherapy after orchiectomy. The other (non-comparative) studies followed men receiving a specific surveillance intervention after orchiectomy.
Each surveillance programme used a slightly different schedule of blood tests, chest X-rays, computed tomography (CT) scans and follow-up visits. Detailed tables of the different schedules were presented in the review.
Reference standard test against which the new test was compared
The review did not include any diagnostic accuracy studies that compared the performance of the index test with a reference standard of diagnosis.
Participants included in the review
Men with clinical stage I testicular cancer were eligible if they met the following criteria: (1) no prior therapy (radiotherapy or retroperitoneal lymph node dissection were prohibited); (2) normal beta-subunit of human chorionic gonadotropin and alpha-fetoprotein levels; (3) normal complete blood count and serum biochemistry; and (4) normal chest X-ray and CT scans of the abdomen, pelvis and lymphangiogram.
A total of 1,174 male outpatients with clinical stage I testicular cancer were included. The authors did not provide details about the participants' age or other characteristics.
Outcomes assessed in the review
The primary outcome measures were survival, relapse rate and salvage rate for men who relapsed. The median time to relapse was a secondary outcome. Studies that did not include one of the primary outcomes were excluded from the review.
How were decisions on the relevance of primary studies made?
The studies were selected and reviewed by one member of the Cancer Care Ontario Practice Guideline Initiative Genitourinary Cancer Disease Site Group and methodologists. Apart from describing the general inclusion criteria and the search strategy, the authors do not state how the papers were selected for the review.