PROGNOSIS OF TESTICULAR TERATOMA DIFFERENTIATED

Objective To determine whether the clinical course of patients with te sticular teratoma differentiated (TD) and those with testicular terato ma undifferentiated justify a different follow-up protocol. Patients a nd methods Between 1979 and 1989, 16 adult patients with testicular TD were treated at the Royal Marsden Hospital, These represented 2.7% of the 592 testicular teratoma patients seen during this period. With th e exception of a propensity to involve the right testis (76%), there w ere no differences in clinical presentation between TD and non-TD hist ological subtypes. Results The mean follow-up was 55 months (range 7-1 37). Seven of the 16 patients had Stage I disease and were entered int o surveillance programmes; one relapsed at 7 months. Ten men were trea ted with cisplatin or carboplatin-based chemotherapy for metastases, o f whom three had had prior chemotherapy at other hospitals and were re ferred after relapse. In the seven previously-untreated chemotherapy g roup two patients failed. Ln the concurrent era, 375 patients with oth er subtypes of metastatic testicular nonseminoma were treated with che motherapy and 47 (12.5%) failed (Progress Free Survival chi square (ch i(2)) = 2.73, P = 0.01). Although no difference in progression-free su rvival was demonstrated between TD and non-TD patients, the former had a worse overall survival probability (chi(2) = 9.02, P = 0.003); this may be an artefact due to the small number of events. Conclusion Desp ite the apparently more benign histology, it is recommended that the m anagement of adult TD should not deviate from the general principles e stablished for other histological subtypes of testicular teratoma.