Late results of surveillance of clinical stage I nonseminoma germ cell testicular tumours: 17 years' experience in a national study in New Zealand

Objective To re-evaluate a national prospective study in New Zealand after 17 years to define whether orchidectomy alone and surveillance for nonsemin oma germ cell testicular tumour (NSGCTT) is a sound policy and matches the results achieved by other treatment protocols, Patients and Methods Between 1980 and 1997. 248 men with stage I NSGCTT, fr om six New Zealand centres, were managed by orchidectomy alone and surveill ance. with treatment of relapses using combination chemotherapy. Results Seventy of the 248 patients (28%) relapsed: 42 of 92 (46%) with vas cular and/or lymphatic invasion (VLI) in the primary tumour relapsed, where as only 26 of 151 (17%) without this feature relapsed (P<0.001). VLI was th e only identifiable risk factor for relapse in this series, Only one relaps e occurred >28 months after orchidectomy, Despite poor compliance in some p atients (12%) their survival was not prejudiced. Three patients died from d isease despite chemotherapy at relapse. Al I; years and a median follow-up of 53 months, 242 of the 248 men are disease-free and the disease-specific survival rate is 98%. Conclusions This study shows that orchidectomy alone and treatment of relap ses produces excellent longterm results without the adverse effects associa ted with retroperitoneal node dissection or elective chemotherapy for high- risk cases.