title: Surgical management of late relapse on surveillance in patients presenting with clinical stage I testicular cancer.
abstract: OBJECTIVE
  To determine survival outcomes in clinical stage I germ cell tumor (GCT) patients requiring retroperitoneal lymph node dissection (RPLND) for late relapse (LR) occurring while on surveillance.
  
  
  METHODS
  The Indiana University Testis Cancer Database was queried from 1985 to 2013 to identify all patients who presented with clinical stage I GCT, elected surveillance, relapsed ≥ 2 years after initial diagnosis, and underwent RPLND in treatment of their LR. Clinical, pathologic, and treatment characteristics were reviewed.
  
  
  RESULTS
  Twenty-eight patients met inclusion criteria. The mean age at diagnosis was 29.3 years. Testicular primary was pure seminoma in 2, intratubular germ cell neoplasia with scar in 1, nonseminomatous GCT in 24, and unknown in 1 patient. The median time from diagnosis to relapse was 48.5 months (range, 28-321 months). At relapse, serum tumor markers were elevated in 13 patients (46.4%). Nineteen patients were given cisplatin-based chemotherapy at LR. RPLND was initial management of LR in 9. At RPLND, 10, 5, and 13 patients demonstrated fibrosis, teratoma, and viable malignancy, respectively. On the last follow-up, 24 patients (85.7%) were free of disease and 4 patients (14.3%) had died of their disease.
  
  
  CONCLUSIONS
  When examining outcomes among patients undergoing RPLND at LR of GCT, it appears that patients experiencing LR on surveillance have more favorable histology and survival outcomes than previously reported for unselected patients experiencing LR.
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana. Electronic address: Kevin_rice777@hotmail.com.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Rice
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana.
authors.forename: Stephen D W
authors.initials: SD
authors.lastname: Beck
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Pedrosa
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana.
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Masterson
authors.affiliation: Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana.
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Einhorn
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Foster
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013997:Time Factors