The changing distribution of stage in nonseminomatous testicular germ celltumours, from 1977 to 1996

Objective. To determine the changes between 1977 and 1996 in the distributi on of stages of testicular cancer (TC). Patients and methods. The stage distribution was assessed, using various cl assifications, i.e. the Royal Marsden (RM), Indiana, European Organization for Research and Treatment of Cancer (EORTC), International Germ Cell Cance r Collaborative Group (IGCCCG) and the Medical Research Council (MRC), in 5 17 patients with nonseminomatous testicular germ cell tumours (NSTGCTs) dia gnosed at a single institution between 1977 and 1996. Results. The number of patients in four consecutive 5-year periods (1977-81 , 1982-86, 1987-91, 1992-96) was 119, 141, 141, and 116, respectively, Freq uency analyses showed a significant increase of RM stage I, in proportion t o stage II-IV, in 1982-86 (55%, odds ratio, OR, 2.54), 1987-91 (53%, OR 2.3 3) and 1992-96 (61%, OR 3.24) compared to the period 1977-81 (33%). A separ ate analysis of patients with disseminated disease showed a proportionate s ignificant decrease of RM stage II in 1992-96 (29%, OR 0.43) compared with 1977-81 (49%). There was also a relative decrease of good-prognosis patient s with disseminated disease in 1992-96 compared with 1977-81, using analyse s of the Indiana (from 56% to 33%, OR 0.39) and EORTC classification (from 78% to 56%, OR 0.36). Analyses of the IGCCCG and MRC classification showed a significant decrease of good-prognosis patients in the 1982-86 compared w ith the first 5-year period (for IGCCCG, from 54% to 35%, OR 0.46, and for MRC, from 43% to 24%, OR 0.42). Conclusion. The stage distribution of NSTGCT over the past two decades has changed. The proportion of stage I patients has increased since the early 1 980s, apparently resulting from a shift of low-extent disseminated disease to stage I disease. This finding is relevant in reducing the treatment requ ired in a higher proportion of patients and the subsequent reduction of lon g-term risk from treatment.