A Surveillance Study of Clinical Stage I Nonseminomatous Germ Cell Tumors of the Testis: 10-Year Followup

Purpose: We evaluate the 10-year results of a surveillance study of clinical stage I nonseminomatous germ cell tumors of the testis. Materials and Methods: Between 1981 and 1984 we recruited 85 consecutive evaluable patients with nonseminomatous germ cell tumors of the testis and normal post-orchiectomy physical examination, chest x-rays, bipedal lymphangiography, abdominal scans and serum tumor markers. The patients were followed for at least 10 years after orchiectomy alone, which was performed elsewhere in 90 percent of the cases. Results: The interval between visits was twice as long as it was scheduled. Relapses occurred in 25 patients (29.4 percent) after a median disease-free interval of 7 months (range 2 to 68). Five patients had further relapses and 3 (3.5 percent) died of cancer. Retroperitoneal relapses (19 percent) occurred later than lung relapses, and they were diagnosed when larger than 5 cm. in 7 patients. The percentage of embryonal carcinoma within the tumor associated with relapse (p = 0.008), T category (p = 0.023), scrotal violation (p = 0.042) and vascular invasion (p = 0.063) had a weak correlation but data on T category and vascular invasion were available for only some patients. Conclusions: Surveillance is a difficult type of study and missing data may compromise the therapeutic program based on prognostic factors.