DETECTION OF RECURRENCE IN PATIENTS WITH CLINICAL STAGE-I NONSEMINOMATOUS TESTICULAR GERM-CELL TUMORS AND CONSEQUENCES FOR FURTHER FOLLOW-UP - A SINGLE-CENTER 1O-YEAR EXPERIENCE

Purpose: A wait-and-see policy for patients with stage I nonseminomato us testicular germ cell tumors (NSTGCT) was evaluated in a prospective study. The frequency and time of recurrence, detection of recurrence, and presence of unfavorable prognostic factors were investigated. Pat ients and Methods: During the period 1982 to 1992, 154 patients with s tage I NSTGCT (median age, 29 years) underwent orchidectomy and were m onitored at follow-up evaluation with physical examinations, alfafetop rotein (AFP) and beta-human choriogonadotropin (hCG) levels, chest x-r ays (CXR), and computed tomographic (CT) scans of the abdomen and ches t. Multivariate logistic regression analyses were performed to identif y prognostic factors. Results: During a median follow-up period of 7 y ears (range, 2 to 12), recurrence was found in 42 patients (27.3%). Al l cases of recurrence were detected within 2 years, 90% in the first y ear after orchidectomy. In 29 patients (69.0%), recurrence was detecte d in the abdominal lymph nodes. Nine patients (21.4%) had metastases i n the retroperitoneum and mediastinum and/or lungs, and four patients (9.6%) had metastases only in the mediastinum or lungs. The majority o f recurrences (97.6%) were detected by tumor markers and CT scans. Rec urrence was related to the presence of vascular invasion, embryonal ca rcinoma (E), elevated preoperative hCG level, and absence of mature te ratoma (M). Only vascular invasion was an independent risk factor. Aft er polychemotherapy treatment for recurrence, the survival rate of the total group was 98.7%. Conclusion: The wait-and-see policy is a relia ble method for follow-up monitoring of patients with stage I NSTGCT. E ven in patients with unfavorable prognostic factors, it is justified t o await the possible appearance of metastases. For the future, it is r ecommended that CXR be omitted from the schedule, and it might be feas ible to discontinue follow-up evaluations after 5 years.