Late relapse (>2 years) on surveillance in stage I non-seminomatous germ cell tumours; predominant seminoma only histology
Article first published online: 24 AUG 2010
© 2010 THE AUTHORS. JOURNAL COMPILATION © 2010 BJU INTERNATIONAL
Volume 106, Issue 11, pages 1648–1651, December 2010
How to Cite
Nolan, L., Wheater, M., Kirby, J., Simmonds, P. and Mead, G. (2010), Late relapse (>2 years) on surveillance in stage I non-seminomatous germ cell tumours; predominant seminoma only histology. BJU International, 106: 1648–1651. doi: 10.1111/j.1464-410X.2010.09471.x
- Issue published online: 15 NOV 2010
- Article first published online: 24 AUG 2010
- Accepted for publication 18 February 2010
- late relapse;
- germ cell cancer
Study Type – Therapy (case series) Level of Evidence 4
Surveillance is a standard management approach following orchidectomy for stage I non-seminomatous and mixed germ cell tumours. Patients who relapse following this approach are treated with cisplatin-based chemotherapy, with retroperitoneal lymph node dissection considered for patients with post-chemotherapy residual masses.
PATIENTS AND METHODS
We reviewed the clinicopathological data for all patients who relapse greater than 24 months after commencing our surveillance programme.
Between 1989 and 2008, 453 patients with a median age of 30 years were entered into our surveillance program for stage I non-seminomatous germ cell tumours (NSGCTs) after orchidectomy alone. All primary tumour specimens contained NSGCT, with seminomatous elements identified in 168 cases (37%). One-hundred patients (22%) relapsed and the majority of relapses occurred within the first 2 years (76 ≤ 12 months, 15 ≥ 12 months ≤ 2 years). Nine patients relapsed after more than 2 years of surveillance. We found a high incidence of pure seminoma (56%) at sites of metastatic disease in this group. All late-relapsing patients were alive and disease free at a median follow up of 45 months from relapse.
We recommend that late-relapsing patients with normal serum alpha fetoprotein levels undergo biopsy to define histologically the nature of recurrent disease. In those with pure seminoma retroperitoneal lymph node dissection for post chemotherapy residual masses can be avoided.