Surveillance can be the standard of care for stage I nonseminomatous testicular tumors and even high risk patients

Purpose: We investigate the results of a surveillance program for stage I n onseminomatous germ cell tumors to validate a surveillance policy, and furt hermore improve it by analyzing diagnostic instruments and identifying prog nostic factors for relapse. Materials and Methods: From 1982 to 1994, 90 patients with stage I nonsemin omatous germ cell tumors entered a surveillance protocol after orchiectomy. Patients with relapse were treated with cisplatin based chemotherapy. A st atistical analysis of possible prognostic factors for relapse was performed . Results: Relapse occurred in 23 (26%) patients. Disease specific survival w as 98.9%, and 1 patient died of tumor. Most relapses were located in retrop eritoneal lymph nodes only (78%). Tumor markers were the most important ind icators of relapse. However, in 22% of patients with relapse abdominal x-ra y of lymphangiographic contrast showed the first sign of relapse. Computeri zed tomography located all but 1 relapse. Vascular invasion (p = 0.0001), t umor size (p = 0.0341) and presence of immature teratoma (p = 0.0154) were significantly predictive of relapse with the multivariate analysis, percent age embryonal carcinoma only by univariate analysis (p = 0.032). The relaps e rate was highest (52%) when vascular invasion was present. Conclusions: With surveillance for stage I nonseminomatous germ cell tumors , excellent treatment results can be achieved that are comparable to primar y retroperitoneal lymph node dissection. Tumor markers and computerized tom ography are highly reliable for detecting relapse. Lymphangiography is stil l of staging value. Pathological factors may influence the choice of adjuva nt treatment. However, relapse risks of 50% to 60% are maximally achieved w ith presently available prognostic factors, and so sparing morbidity of adj uvant treatment by a surveillance protocol remains a feasible option even i n these patients.