Abdominal relapse in stage 1 nonseminomatous germ cell tumours of the testis managed by surveillance or with adjuvant chemotherapy

Objective To assess the impact on patterns of recurrence of adjuvant chemot herapy in patients with stage 1 nonseminomatous germ cell tumours (NSGCT) o f the testis. who have a high likelihood of relapse on surveillance if cert ain risk factors are identified in the orchidectomy specimen. and thus the theoretical need for retroperitoneal lymph node dissection (RPLND). Patients and methods The incidence of abdominal relapse was recorded in 417 men presenting with stage 1 NSGCT over the past 18 years, Up to 1986, 161 men were managed by surveillance alone, and abdominal relapse occurred in 2 6. From 1986 onwards, men with positive risk factors in the orchidectomy sp ecimen were offered two courses of chemotherapy; 60 accepted and one relaps ed in the abdomen, and 196 underwent surveillance and 19 relapsed in the ab domen. Results Abdominal relapse was significantly reduced from 16% before 1986 to 8% afterward (P = 0.014). Mortality from testicular tumour or treatment to xicity remained low, at 0.6% before 1986 and 2.0% since then. Conclusion The need for RPLND in stage 1 NSGCT remains highly doubtful.