title: Late recurrence and second primary malignancy among 139 patients with germ cell tumors: long-term outcome of the disease in a single-center experience.
abstract: OBJECTIVE
  We retrospectively evaluated long-term oncological outcomes in patients with germ cell tumors (GCTs) primarily treated at our institution and assessed late recurrence and second primary malignancies.
  
  
  METHODS
  This study included a total of 139 males with newly diagnosed GCTs of the testis or extragonadal origin who received treatment, including surgery, chemotherapy and radiation therapy, at our hospital between 1980 and 2005. We reviewed late recurrence that occurred at least 2 years after the initial disease-free status and secondary malignancies as well as oncological outcomes.
  
  
  RESULTS
  In patients with seminoma, 5-year progression-free survival and cause-specific survival rates were 87.2% and 100% for Stage I, 88.9% and 100% for Stage II, and 50.0% and 50.0% for Stage III, respectively, whereas in those with non-seminomatous GCTs, they were 79.1% and 96.3% for Stage I, 89.5% and 89.4% for Stage II, and 85.7% and 78.4% for Stage III, respectively. Late recurrence was found in five (3.6%) patients and all of them responded to salvage treatment and achieved disease-free status. Second primary hematological neoplasms occurred in three (2.2%), although they had a long-term free of the primary disease. All died of the second primary disease.
  
  
  CONCLUSIONS
  Late recurrence was successfully managed with appropriate treatments, although its incidence was not negligible. Periodic follow-up may be necessary for >5 years in patients with GCTs for early detection of late recurrence. In addition, care should be taken to watch for the development of life-threatening second primary malignant disease during long-term follow-up.
authors.affiliation: Department of Urology, Sapporo Medical University, Sapporo, Japan. shun@sapmed.ac.jp
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Sato
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Tanaka
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
authors.forename: Masamichi
authors.initials: M
authors.lastname: Sasai
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kitamura
authors.forename: Naoya
authors.initials: N
authors.lastname: Masumori
authors.forename: Taiji
authors.initials: T
authors.lastname: Tsukamoto
mesh_terms: D000293:Adolescent; D000328:Adult; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology* / Q000628:therapy; D016609:Neoplasms, Second Primary / Q000473:pathology* / Q000628:therapy; D012189:Retrospective Studies; D018239:Seminoma / Q000473:pathology / Q000628:therapy; D013736:Testicular Neoplasms / Q000473:pathology* / Q000628:therapy; D013997:Time Factors