Excellent outcome in patients with stage I germ cell tumors of the testes: a study of the Children's Cancer Group/Pediatric Oncology Group.
OBJECTIVE
The aim of this study was to correlate outcomes in patients with stage I testicular germ cell tumors with compliance to surgical guidelines and to confirm previous single-institution experiences that show excellent disease-free survival rates when treated with orchiectomy alone.


METHODS
Sixty-three patients were entered into this intergroup study (Children's Cancer Group 8881/Pediatric Oncology Group 9048) between 1990 and 1996. Surgical guidelines for orchiectomy included an inguinal approach, early vascular control of the cord structures, and a hemiscrotectomy if a transscrotal violation occurred. Failure of tumor marker normalization or subsequent elevation suggested advanced disease requiring further surgery and chemotherapy. Survival curves were compared using the log-rank test.


RESULTS
The median age was 16 months (range, 1 month to 5.6 years). Progression of disease occurred in 11 patients. The 6-year event-free survival (EFS) was 78.5% + 7%. The overall 6-year survival rate was 100%. Adherence to all guidelines was confirmed in only 43 patients (69%). Overall, there was no statistical significance in event-free survival rates between patients who had a correct surgical approach and all patients who had surgical violations; however, 4 patients with transscrotal violations showed a significantly higher rate of disease recurrence.


CONCLUSIONS
Patients with stage I germ cell tumors of the testes have excellent survival rates when treated with surgery alone. Despite numerous surgical guideline violations, event-free survival in this multiinstitutional study was similar to previous single-institution reports. All patients with relapse or progression of their disease appear to be cured with further surgical excision and chemotherapy.
Schlatter
Marc
M
DeVos Children's Hospital, 330 Barclay, Suite 202, Grand Rapids, Michigan 49503, USA.
Rescorla
Fred
F
Giller
Roger
R
Cushing
Barbara
B
Vinocur
Charles
C
Colombani
Paul
P
Cullen
John
J
London
Wendy
W
Davis
Mary
M
Lauer
Stephen
S
Olson
Thomas
T
D017024:Chemotherapy, Adjuvant; D002675:Child, Preschool; D018572:Disease-Free Survival; D018237:Germinoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009367:Neoplasm Staging; D009919:Orchiectomy; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome