Table 1.
Study criteria.
| Study | Inclusion period | Country | Inclusion criteria for AS | Patients, n | Age, years, median (range) | Follow‐up, months, median (range) | Overall metastatic rate, % | Central pathology review | Overall risk of bias |
|---|---|---|---|---|---|---|---|---|---|
| AS studies | |||||||||
| Gilbert et al. 2016 [15] | NR | UK | NR | 177 | NR | NR | NR | Yes | High |
| Li et al. 2015 [16] | 1999–2013 | China | NR | 78 | 29.5 (14–56) | 74.4 (12–180) | 23.1 | Yes | High |
| Kollmannsberger et al. 2015 [1] | 1983–2012 | Canada, Norway, Sweden, UK, USA | NR | 1139 | 30 (14–85) | 62 (1–277) | 19.4 | No | High |
| Daugaard et al. 2014 [17] | 1984–2007 | Denmark | Standard policy | 1226 | 30 (15–79) | 180 (1–346) | 31.2 | No | Moderate |
| Keskin et al. 2011 [18] | 2002–2009 | Turkey | Patient preference | 70 | 27.8 (16–67) | 18.5 (6–71) | 17.1 | Yes | High |
| Sturgeon et al. 2011 [19] | 1981–2005 | Canada | Preferred management option, no pure choriocarcinoma | 371 | Mean 30.5 (13.2–76.6) | 75.6 (0.96–310.8) | 28.0 | Yes | Moderate |
| Kollmannsberger et al. 2010 [20] | 1998–2007 | Canada | Preferred management option | 223 | 29 (15–63) | 52 (3–136) | 26.5 | Yes | Moderate |
| Atsü et al. 2003 [21] | 1978–2000 | Turkey | Normalization of markers | 132 | 28 (16–52) | 38 (6–265) | 24.2 | Yes | High |
| Daugaard et al. 2003 [22] | 1984–2002 | Denmark | Standard policy | 301 | 34 (15–72) | 60 (1–226) | 28.6 | No | High |
| Alexandre et al. 2001 [23] | 1984–1996 | France | Patient preference, not based on histopathological characteristics | 88 | 30.5 (15.9–55.7) | 51.6 (12–144) | 27.3 | Yes | Moderate |
| Roeleveld et al. 2001 [24] | 1982–1994 | The Netherlands | No pure choriocarcinoma, no history of any previous tumour | 90 | Mean 30 (16–60) | 97.2 | 25.6 | Yes | Moderate |
| Colls et al. 1999 [25] | 1980–1997 | New Zealand | Histological NSGCT, seminoma with β‐HCG ≥300 IU/L, or seminoma with elevated AFP | 248 | 29 (16–77) | 53 (1–185) | 28.2 | No | High |
| Sogani et al. 1998 [26] | 1979–1987 | USA | No T2–T4, no pure choriocarcinoma, no pure seminoma, no history of orchidopexy, no unreliability for close follow‐up | 105 | 26 (15–46) | 135.6 (28.8–201.6) | 25.7 | Yes | High |
| Maher and Lee 1998 [27] | 1980–1993 | UK | Standard policy | 42 | 28 (18–53) | 79.4 (30.6–183.2) | 31.0 | Yes | High |
| Gels et al. 1995 [28] | 1982–1992 | The Netherlands | Standard policy | 154 | 29 (15–66) | 84 (24–144) | 27.3 | No | Moderate |
| Nicolai and Pizzocaro 1995 [29] | 1981–1984 | Italy | Offered to all CS I patients, no tumour at cut end of spermatic cord | 85 | NR | 132 (114–156) | 29.4 | Yes | High |
| Ondrus and Hornak 1994 [30] | 1984–NR | Slovakia | No seminoma or choriocarcinoma component | 80 | 27 (13–58) | Mean: 83.1 (61–110) | 36.3 | NR | High |
| Tekgül et al. 1995 [31] | 1985–1994 | Turkey | No tumour at cut end of spermatic cord, eligible for close and proper AS | 58 | 31 (17–43) | 39 (14–79) | 29.3 | Yes | High |
| Read et al. 1992 [32] | 1984–1987 | UK and Norway | No tumour at cut end of spermatic cord | 373 | NR | 60 | 26.8 | Yes | Moderate |
| Sturgeon et al. 1992 [33] | 1981–NR | Canada | Preferred management option, no pure choriocarcinoma | 105 | 28 (17–76) | 60 (12–121) | 35.2 | Yes | Moderate |
| Rørth et al. 1991 [34] | 1980–1984 | Denmark | Randomisation | 83 | 30 (17–64) | 64 (33–103) | 27.7 | Yes | High |
| Wishnow et al. 1989 [46] | 1981–1987 | USA | NR | 82 | NR | NR | 29.3 | Yes | High |
| Dunphy et al. 1988 [35] | 1981–1986 | USA | NR | 93 | Mean 28 (16–54) | 34 (12–61) | 30.1 | Yes | Moderate |
| Thompson et al. 1988 [36] | 1979–NR | New Zealand | No tumour at cut end of spermatic cord | 36 | 27 (18–45) | 36 (14–92) | 33.3 | Yes | High |
| Freedman et al. 1987 [37] | 1979–1983 | UK | NR | 259 | NR | 30 (10–63) | 27.0 | Yes | Moderate |
| Hoskin et al 1986 [38] | 1979–1985 | UK | Histological NSGCT or seminoma with elevated AFP, no tumour at cut end of spermatic cord | 126 | NR | 42 | 28.6 | Yes | Moderate |
| Primary RPLND studies | |||||||||
| Nicolai et al. 2011* [39] | 2002–2007 | Italy | NR | 183 | NR | NR | 18.6 | Yes | Moderate |
| Albers et al. 2003† [10] | 1996–2002 | Germany | CS I, randomisation | 165 | Mean 31.3 (SD 8.3) | Mean 34.5 (12–64) | 37.6 | Yes | Moderate |
| Spermon et al. (2002)* [40] | 1986–1992 | The Netherlands | NR | 50 | NR | NR | 30.0 | Yes | High |
| Sweeney et al. 2000† [43] | 1990–1995 | USA | NR | 292 | NR | 46 (24–89) | 30.5 | Yes | Moderate |
| Albers et al. 1997† [47] | 1983–1994 | Germany | NR | 78 | NR | Mean 58.2 (8–149) | 35.9 | Yes | High |
| Albers et al. (1995)* [45] | 1992–1993 | USA | CS I | 90 | NR | Mean 15.9 (5–27) | 27.8 | Yes | High |
| Moul et al. 1994* [44] | 1980–1993 | USA | NR | 92 | NR | NR (1–10) | 41.3 | Yes | High |
| Klepp et al. 1990† [42] | 1981–1986 | Sweden, Norway | CS I, no previous malignancy | 279 | NR | 50 (30–90) | 37.6 | Yes | Moderate |
| Fung et al. 1988* [41] | 1979–1987 | USA | NR | 60 | 25 (15–56) | 18 (NR) | 33.3§ | Yes | Moderate |
| Total | 1978–2013 | 7113‡ | |||||||
AFP, α‐fetoprotein; β‐HCG, β‐human chorionic gonadotropin; NR, not reported. *Study endpoint is pathological Stage II. †Study endpoint is pathological Stage II or relapse after pathological Stage I. ‡Includes patients reported in multiple studies. §48.3% including patients with relapse after pathological Stage I.