Late results of surveillance of clinical stage I nonseminoma germ cell testicular tumours: 17 years’ experience in a national study in New Zealand

Abstract

Objective To re-evaluate a national prospective study in for relapse in this series. Only one relapse occurred >28 months after orchidectomy. Despite poor comNew Zealand after 17 years to define whether orchidectomy alone and surveillance for nonseminoma pliance in some patients (12%) their survival was not prejudiced. Three patients died from disease despite germ cell testicular tumour (NSGCTT) is a sound policy and matches the results achieved by other chemotherapy at relapse. At 17 years and a median follow-up of 53 months, 242 of the 248 men are treatment protocols. Patients and methods Between 1980 and 1997, 248 disease-free and the disease-specific survival rate is 98%. men with stage I NSGCTT, from six New Zealand centres, were managed by orchidectomy alone and Conclusions This study shows that orchidectomy alone and treatment of relapses produces excellent longsurveillance, with treatment of relapses using combination chemotherapy.term results without the adverse eCects associated with retroperitoneal node dissection or elective chemoResults Seventy of the 248 patients (28%) relapsed; 42 of 92 (46%) with vascular and/or lymphatic invasion therapy for high-risk cases. Keywords Stage I nonseminoma, testicular cancer, (VLI) in the primary tumour relapsed, whereas only 26 of 151 (17%) without this feature relapsed surveillance, long-term follow-up, orchidectomy (P<0.001). VLI was the only identifiable risk factor ommend that high-risk patients should be oCered adju-

Testicular hilum and vascular invasion predict advanced clinical stage in nonseminomatous germ cell tumors

“…We also confirmed that vascular invasion is a significant risk factor for metastasis in nonseminomatous germ cell tumors, which is well documented previously. [2][3][4]9,10,[13][14][15][16][17][18][19] Clinical stage is the most critical step in the management of patients diagnosed with nonseminomatous germ cell tumors. A current challenge is the appropriate management of clinical stage I disease because of the concerns related to the adverse effects of the chemotherapy treatment.…”

Current Update of Management of Clinical Stage I Non Seminomatous Germ Cell Tumors of Testis

“…A randomized trial evaluated CT scans at three and 12 months versus three, six, nine, 12, and 24 months and found no benefit in more frequent CT scans [14]. The largest reports of the surveillance strategy indicate a cumulative relapse rate of about 30%, with 80% of the relapses occurring during the first 12 months of follow-up, 12% during the second year and 6% during the third year, decreasing to 1% during the fourth and fifth years, and occasionally even later [15,16]. About 35% of relapsing patients have normal levels of serum tumor markers at relapse.…”

Current Concepts in Management of Stage I NSGCT

“…Subsequent studies have shown that vascular invasion (VI) is the single most important prognostic factor regarding risk of relapse [14][15][16][17]. Without adjuvant treatment, the high-risk group (VI positive) has a 3-year relapse rate of approximately 50%, while low-risk patients (VI negative) have a relapse risk of 10 to 20% [1,3,[16][17][18][19][20][21][22].…”

“…The largest reports of the surveillance strategy indicate a cumulative relapse rate of about 30%, with 80% of relapses occurring during the first 12 months of follow-up, 12% during the second year and 6% during the third year, decreasing to 1% during the fourth and fifth years, and occasionally even later [1,3,12,25]. About 35% of relapsing patients have normal levels of serum tumour markers at relapse.…”

“…The controversy however remains over the choice of modality since patients have an excellent survival with all the modalities with cancer-specific survival rates of 98 to 99%. Furthermore, from large surveillance series, we know that 25 to 30% of patients diagnosed with CS1 disease ultimately will relapse due to occult microscopic retroperitoneal lymph node metastases, which cannot be reliably detected by modern imaging studies, tumour markers or molecular approaches [1][2][3]. The risks and benefits of treatment modalities differ [4].…”