title: Does delayed diagnosis or scrotal incision affect outcome for men with non-seminomatous germ cell tumours?
abstract: OBJECTIVE
  To ascertain whether delayed diagnosis or type of orchidectomy affected outcome for men with non-seminomatous germ cell tumours (NSGCT).
  
  
  METHODS
  The case notes of 454 men resident in the west of Scotland with a diagnosis of NSGCT between 1975 and 1989 were retrospectively reviewed. The clinical record was available for 442 (97%) and included information on time to diagnosis in 92% and diagnostic surgery in 97%. The study end-point for orchidectomy was loco-regional recurrence and for diagnostic delay was survival.
  
  
  RESULTS
  A significant minority of men (10.4%) underwent a scrotal orchidectomy or had a scrotal incision before an inguinal orchidectomy (9.4%). More scrotal incisions were performed on patients under the care of general surgeons (28%) than of urologists (12.1%). Of the men who had scrotal surgery, one of 78 (1.3%; 95% CI, 0-4%) developed loco-regional disease as the initial site of recurrence, compared with none of 318 men undergoing inguinal orchidectomy. The median time to diagnosis was 3 months. There was no relationship between time to diagnosis and tumour extent at presentation. A diagnostic delay of > 3 months was associated with inferior survival in univariate analysis, but delayed diagnosis was not an independent influence on survival after adjustment for the major prognostic factors--tumour extent, year of diagnosis and treatment unit.
  
  
  CONCLUSIONS
  These results suggest that scrotal incision is unlikely to affect the risk of loco-regional recurrence and that effective cytotoxic therapy has probably reduced the prognostic importance of delayed diagnosis on survival of men with NSGCT.
authors.affiliation: Cancer Research Campaign Department of Medical Oncology, Beatson Oncology Centre, Western Infirmary, Glasgow, UK.
authors.forename: M
authors.initials: M
authors.lastname: Harding
authors.forename: J
authors.initials: J
authors.lastname: Paul
authors.forename: S B
authors.initials: SB
authors.lastname: Kaye
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009919:Orchiectomy; D011379:Prognosis; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D012611:Scrotum / Q000601:surgery; D013724:Teratoma / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D013736:Testicular Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D013997:Time Factors