title: Late relapse (>2 years) on surveillance in stage I non-seminomatous germ cell tumours; predominant seminoma only histology.
abstract: OBJECTIVE
  Surveillance is a standard management approach following orchidectomy for stage I non-seminomatous and mixed germ cell tumours. Patients who relapse following this approach are treated with cisplatin-based chemotherapy, with retroperitoneal lymph node dissection considered for patients with post-chemotherapy residual masses.
  
  
  METHODS
  We reviewed the clinicopathological data for all patients who relapse greater than 24 months after commencing our surveillance programme.
  
  
  RESULTS
  Between 1989 and 2008, 453 patients with a median age of 30 years were entered into our surveillance program for stage I non-seminomatous germ cell tumours (NSGCTs) after orchidectomy alone. All primary tumour specimens contained NSGCT, with seminomatous elements identified in 168 cases (37%). One-hundred patients (22%) relapsed and the majority of relapses occurred within the first 2 years (76 ≤ 12 months, 15 ≥ 12 months ≤ 2 years). Nine patients relapsed after more than 2 years of surveillance. We found a high incidence of pure seminoma (56%) at sites of metastatic disease in this group. All late-relapsing patients were alive and disease free at a median follow up of 45 months from relapse.
  
  
  CONCLUSIONS
  We recommend that late-relapsing patients with normal serum alpha fetoprotein levels undergo biopsy to define histologically the nature of recurrent disease. In those with pure seminoma retroperitoneal lymph node dissection for post chemotherapy residual masses can be avoided.
authors.affiliation: Cancer Research UK Clinical Centre, Cancer Sciences Division, School of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK. ln@soton.ac.uk
authors.forename: Luke
authors.initials: L
authors.lastname: Nolan
authors.forename: Matthew
authors.initials: M
authors.lastname: Wheater
authors.forename: Julie
authors.initials: J
authors.lastname: Kirby
authors.forename: Peter
authors.initials: P
authors.lastname: Simmonds
authors.forename: Graham
authors.initials: G
authors.lastname: Mead
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001706:Biopsy; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology* / Q000628:therapy; D009919:Orchiectomy; D013736:Testicular Neoplasms / Q000473:pathology* / Q000628:therapy; D057832:Watchful Waiting; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000970:Antineoplastic Agents; D000509:alpha-Fetoproteins; D002945:Cisplatin