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


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.


RESULTS
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%.


CONCLUSIONS
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.
Colls
B M
BM
Oncology Services, Christchurch Hospital, New Zealand.
Harvey
V J
VJ
Skelton
L
L
Frampton
C M
CM
Thompson
P I
PI
Bennett
M
M
Perez
D J
DJ
Dady
P J
PJ
Forgeson
G V
GV
Kennedy
I C
IC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D018237:Germinoma / Q000453:epidemiology / Q000556:secondary / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D009520:New Zealand / Q000453:epidemiology; D009919:Orchiectomy / Q000706:statistics & numerical data*; D010349:Patient Compliance; D011446:Prospective Studies; D013736:Testicular Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*