PURPOSE: To  analyze, in the setting of @entity5 , the factors affecting @entity1753 decisions and resulting survival outcomes, using a national dataset. METHODS AND MATERIALS: We identified 33,094 @entity5 @entity1 after orchiectomy from 1998 to 2012 from the National Cancer Data Base. Factors affecting treatment selection ( @entity3457 [ @entity3457 ] vs @entity1753 [ @entity1753 ]) were identified using a parsimonious multivariate logistic regression model. Propensity scores for treatment decision were generated and incorporated into a multivariate Cox regression analysis of overall survival. This process was then repeated within the @entity1753 cohort for factors predictive for chemotherapy [CT] versus radiation therapy [RT]. RESULTS: Only 33% of @entity1 received @entity3457 , and 65% received @entity1753 (89% RT and 11% CT). From 1998 to 2012 the proportion receiving @entity3457 increased from 23% to 60%, whereas RT utilization decreased from 73% to 21%, and CT utilization increased from 2% to 17%. Utilization of low-dose RT increased from 1.5% in 1999 to 34% in 2012. There was a small absolute overall survival advantage to @entity1753 over @entity3457 at 10  years (95.0% vs 93.4%, propensity adjusted hazard ratio 0.58, P<.0005). CONCLUSIONS: There has been a significant increase in use of @entity3457 for @entity5 , influenced by both sociodemogrpahic and clinicopathologic factors. Between @entity1753 options, there has been significant increase in use of CT, mirrored by a decline in use of RT. Although overall survival remains high for all 3 treatment strategies, @entity1753 seems to be associated with a small absolute survival advantage over @entity3457 up to 10  years out from diagnosis.

Surveillance and Radiation Therapy for XXXX -Have We Learned From the Evidence?

@entity5 :: ('MESH:D009369', 'Disease') :: ['stage I seminoma'] @entity1 :: ('9606', 'Species') :: ['patients'] @entity3457 :: ('OMIM:612348', 'Disease') :: ['active surveillance', 'AS'] @entity1753 :: ('MESH:D001169', 'Disease') :: ['AT', 'adjuvant treatment']
@entity5 :: (MESH:D009369,Disease) :: ['Stage I Seminoma']
