title: Late Relapses in Stage I Testicular Cancer Patients on Surveillance.
abstract: Comprehensive data on late relapse (LR) and very LR (VLR) in patients with clinical stage I (CS-1) testicular cancer followed on surveillance are missing. These data are essential for planning optimal follow-up.
  
  
  
  Assess incidence and outcome of LR (>2 yr) and VLR (>5 yr) in a large cohort of CS-1 surveillance patients, and examine differences in the clinical characteristics of patients with early relapse (ER), LR, and VLR.
  
  
  
  CS-1 surveillance patients diagnosed between 1984 and 2007 were identified from the retrospective Danish Testicular Cancer (DaTeCa) database.
  
  
  
  We estimated survival and relapse probabilities and compared the results using log-rank tests and Cox regression analyses. We compared differences in patient characteristics by using χ(2), Fisher exact, and Mann-Whitney tests.
  
  
  
  Our study included 3366 (2000 seminoma and 1366 nonseminoma) patients. Median follow-up was 15 yr. Five-year conditional risk of LR was 5.0% and 2.1% for seminoma and nonseminoma patients, respectively. There were no significant differences in disease-specific or overall survival when comparing the LR(VLR) and ER patients by log-rank, but Cox regression adjusted for age showed a significant effect of time to relapse on survival for seminoma patients. Apart from significantly more ER nonseminoma patients with elevated human chorionic gonadotropin at relapse, there were no significant differences in patient characteristics at orchiectomy or relapse. Limitations include retrospective design and exclusion of patients who had been offered adjuvant therapy.
  
  
  
  The risk of VLR is minimal, and the patients carry a good prognosis. Patient characteristics of CS-1 surveillance patients with LR(VLR) do not differ significantly from patients with ER.
  
  
  
  We compared stage I testicular cancer surveillance patients with early relapse (ER) versus late relapse (LR; >2 yr). LR patients as a group did no worse than ER patients, although increased time to relapse was negatively associated with survival for seminoma patients.
authors.affiliation: Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark. Electronic address: mette.saksoe.mortensen@regionh.dk.
authors.forename: Mette Saksø
authors.initials: MS
authors.lastname: Mortensen
authors.affiliation: Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Jakob
authors.initials: J
authors.lastname: Lauritsen
authors.affiliation: Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark; Danish Cancer Society, Copenhagen, Denmark.
authors.forename: Maria Gry Gundgaard
authors.initials: MG
authors.lastname: Kier
authors.affiliation: Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Mikkel
authors.initials: M
authors.lastname: Bandak
authors.affiliation: Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Ane Lindegaard
authors.initials: AL
authors.lastname: Appelt
authors.affiliation: Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Mads
authors.initials: M
authors.lastname: Agerbæk
authors.affiliation: Department of Oncology, Odense University Hospital, Odense, Denmark.
authors.forename: Niels Vilstrup
authors.initials: NV
authors.lastname: Holm
authors.affiliation: Department of Oncology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Mette Moe
authors.initials: MM
authors.lastname: Kempel
authors.affiliation: Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Hans
authors.initials: H
authors.lastname: von der Maase
authors.affiliation: Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Gedske
authors.initials: G
authors.lastname: Daugaard
mesh_terms: D000328:Adult; D000368:Aged; D006063:Chorionic Gonadotropin / Q000032:analysis; D003718:Denmark / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D000069451:Long Term Adverse Effects / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009919:Orchiectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D012008:Recurrence; D012189:Retrospective Studies; D018239:Seminoma / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000401:mortality / Q000473:pathology
chemical_list: D006063:Chorionic Gonadotropin
keywords: Late relapse; Nonseminoma; Seminoma; Stage I germ cell cancer; Surveillance