PROGNOSTIC FACTORS FOR RELAPSE IN STAGE-I TESTICULAR SEMINOMA TREATEDWITH SURVEILLANCE

Purpose: We sought to identify prognostic factors predictive of diseas e progression in patients with clinical stage I seminoma on surveillan ce following orchiectomy. Materials and Methods: Between January 1981 and December 1993, 201 patients 20 to 86 years old (median age 34) wit h clinical stage I seminoma were placed on surveillance following orch iectomy. The potential prognostic factors studied included age, tumor size, mitotic count, S phase fraction, ploidy, presence of small vesse l invasion, syncytiotrophoblasts and tumor infiltrating lymphocytes, e xpression of beta-human chorionic gonadotropin and low molecular weigh t keratin on immunohistochemistry. Results: With a median followup of 6.1 years (range 1.3 to 12.3) 31 patients had relapse for an actuarial 5-year relapse-free rate of 84.9%. The 5-year actuarial survival rate was 97.1% and the cause specific survival rate was 99.5%. On univaria te analysis factors predictive of relapse were tumor size (5-year rela pse-free rate 88 and 67% for tumors 6 cm. or less and greater than 6 c m., respectively, p = 0.004), age (5-year relapse-free rate 79 and 91% for age 34 years or younger versus older than 34 years, respectively, p = 0.009) and presence of small vessel invasion (5-year relapse-free rate 86 versus 69%, p = 0.01). On multivariate analysis age and tumor size were predictive of relapse, while small vessel invasion approach ed statistical significance. The risk of relapse in 57 patients with n one of the 3 adverse prognostic factors (age greater than 34 years, tu mor 6 cm. or smaller and no small vessel invasion) was 6%. Conclusions : We identified age, size of the primary tumor and small vessel invasi on as important prognostic factors for relapse in patients with stage I seminoma treated with surveillance. Further followup and assessment of biological factors are needed to optimize selection of patients at a high risk for relapse who should receive immediate postoperative the rapy.