Late results of surveillance of clinical stage I nonseminoma germ cell testicular tumours: 17 years’ experience in a national study in New Zealand
Version of Record online: 28 JUN 2008
Volume 83, Issue 1, pages 76–82, January 1999
How to Cite
Colls, B.M., Harvey, V.J., Skelton, L., Frampton, C.M.A., Thompson, P.I., Bennett, M., Perez, D.J., Dady, P.J., Forgeson, G.V. and Kennedy, I.C.S. (1999), Late results of surveillance of clinical stage I nonseminoma germ cell testicular tumours: 17 years’ experience in a national study in New Zealand. BJU International, 83: 76–82. doi: 10.1046/j.1464-410x.1999.00869.x
- Issue online: 28 JUN 2008
- Version of Record online: 28 JUN 2008
- Stage I nonseminoma;
- testicular cancer;
- long-term follow-up;
To re-evaluate a national prospective study in New Zealand after 17 years to define whether orchidectomy alone and surveillance for nonseminoma germ cell testicular tumour (NSGCTT) is a sound policy and matches the results achieved by other treatment protocols.
Patients and methods
Between 1980 and 1997, 248 men with stage I NSGCTT, from six New Zealand centres, were managed by orchidectomy alone and surveillance, with treatment of relapses using combination chemotherapy.
Seventy of the 248 patients (28%) relapsed; 42 of 92 (46%) with vascular and/or lymphatic invasion (VLI) in the primary tumour relapsed, whereas only 26 of 151 (17%) without this feature relapsed (P<0.001). VLI was the only identifiable risk factor for relapse in this series. Only one relapse occurred >28 months after orchidectomy. Despite poor compliance in some patients (12%) their survival was not prejudiced. Three patients died from disease despite chemotherapy at relapse. At 17 years and a median follow-up of 53 months, 242 of the 248 men are disease-free and the disease-specific survival rate is 98%.
This study shows that orchidectomy alone and treatment of relapses produces excellent long-term results without the adverse effects associated with retroperitoneal node dissection or elective chemotherapy for high-risk cases.