Results of the Surveillance Policy of Stage I Non‐seminomatous Germ Cell Testicular Tumours

Abstract

A series of 115 patients with clinical Stage I non-seminomatous germ cell testicular tumours were managed with orchiectomy and close surveillance (median follow-up 36 months, range 3-119); 34 (29.5%) relapsed, 21 within 6 months, 29 within a year and the latest at 28 months. At relapse all patients were treated with platinum or analogue-based drug combinations, supplemented in 7 by retroperitoneal node dissection; 30 patients achieved durable remissions and 2 have had further relapses successfully treated. Two died; both had malignant teratoma intermediate with primary stage T1 and vascular and/or lymphatic invasion of primary tumour. At a median follow-up time of 36 months, the survivors (98.3%) demonstrate no evidence of disease, these results matching the outcome of other methods of management. Vascular and/or lymphatic invasion was associated with an enhanced relapse rate but specific histology, T stage of the primary and pre-orchiectomy serum alpha-fetoprotein status did not appear to favour relapse. The first sign of relapse was tumour marker alone in 10 patients, radiological features alone in 12, or both in 10 patients. However, in 2 cases the relapse was first detected clinically. Furthermore, pre-orchiectomy and relapse marker status did not correlate well. These points emphasise the importance of all aspects of follow-up, none of which can be safely omitted.

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

“…These results are similar to those of an earlier report, when the study included only 115 patients with a disease‐specific survival of 98.3% at a median follow‐up of 36 months. The later results confirm our earlier impression that surveillance of Stage I NSGCTT is an appropriate management technique [3]. These results are similar to those reported by others who practise surveillance alone after orchidectomy for clinical Stage I NSGCTT [4,5,16].…”

“…The presence or absence or vascular and/or lymphatic invasion (VLI) in the primary tumour was noted, this phenomenon having been identified by ourselves and others as the prognostic factor of greatest significance [3,8,11,12]. VLI were grouped together because of the recognized difficulty experienced by histologists in differentiating vascular channels and lymphatic vessels in such patients.…”

“…Since then, many groups have reported the results of surveillance of such patients. This practice has become increasingly popular, with results that match those achieved by RPLND [2–6]. As it is now realized that some patients with stage I disease have a higher risk of relapse, the concept of adjuvant chemotherapy has been proposed for this subgroup.…”

A novel surveillance protocol for stage I nonseminomatous germ cell testicular tumours

“…Likewise RPLND is still associated with ejaculation problems, as nerve-sparing techniques are not commonly available. We obtained similar survival rates to those reported previously for RPLND and primary chemotherapy [4,13,14].…”

Follow‐up of clinical stage I testicular cancer patients: Cost and risk benefit considerations

“…11 The literature review in the present study indicates that 4 years of follow-up is enough for this category of patients with a consequence of improved diagnostic procedures. 9,[12][13][14] If intensive follow-up can be stopped 4 years after orchiectomy, the cost of surveillance will be compatible to primary RPLND. However, physical examination should continue to check for contralateral metachronous testis tumor, which can occur in approximately 3% of the patients.…”