title: Late recurrence in 1263 men with testicular germ cell tumors. Multivariate analysis of risk factors and implications for management.
abstract: BACKGROUND
  Testicular germ cell tumors are highly curable. However, 10-30% of patients have recurrence after initial treatment. The time-course of recurrence has implications for the duration of follow-up. This study was undertaken to assess the risk and time-course of recurrence and to identify patients at higher risk of late recurrence.
  
  
  METHODS
  The records of 1263 patients with primary testicular germ cell tumors presenting to the Royal Marsden Hospital between December 1979 and December 1993 were reviewed. In all, 255 episodes of recurrence were documented (including 44 patients with multiple recurrences) and used to calculate recurrence-free survivals.
  
  
  RESULTS
  Fifty-three patients (15 seminomas; 38 nonseminomatous germ cell tumors [NSGCT]) had recurrence more than 2 years after initial presentation. A multivariate analysis of risk of recurrence after 2 years identified positive markers at presentation and the presence of differentiated teratomas in postchemotherapy surgical specimens as significant predictors. Very late recurrence (> 5 years) occurred mainly in patients with metastatic NSGCT (12 of 14 patients) with a 1% annual risk of recurrence between 5 and 10 years. Very late recurrence was also seen in one case of metastatic seminoma and one case of Stage I NSGCT managed by surveillance. Most late recurrences (n = 9) were detected at routine annual follow-up visits but five had recurrences with symptoms leading to an unscheduled clinic visit.
  
  
  CONCLUSIONS
  Late recurrences are rare in patients with testicular germ cell tumors and follow-up to detect recurrence may not be needed after 5 years, except in those presenting with metastatic NSGCTs.
authors.affiliation: Academic Department of Radiotherapy and Oncology, The Royal Marsden NHS Trust, Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom. mehdi@icr.ac.uk
authors.forename: Mehdi
authors.initials: M
authors.lastname: Shahidi
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Norman
authors.forename: David P
authors.initials: DP
authors.lastname: Dearnaley
authors.forename: Judy
authors.initials: J
authors.lastname: Nicholls
authors.forename: Alan
authors.initials: A
authors.lastname: Horwich
authors.forename: Robert A
authors.initials: RA
authors.lastname: Huddart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005500:Follow-Up Studies; D018237:Germinoma / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012307:Risk Factors; D018239:Seminoma / Q000473:pathology; D013736:Testicular Neoplasms / Q000473:pathology* / Q000628:therapy; D013997:Time Factors