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 nonseminoma 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, from six New Zealand centres, were managed by orchidectomy alone and surveillance. with treatment of relapses using combination chemotherapy. Results Seventy of the 248 patients (28%) relapsed: 42 of 92 (46%) with vascular and/or lymphatic invasion (VLI) in the primary tumour relapsed, whereas only 26 of 151 (17%) without this feature relapsed (P<0.001). VLI was the only identifiable risk factor for relapse in this series, Only one relapse occurred >28 months after orchidectomy, Despite poor compliance in some patients (12%) their survival was not prejudiced. Three patients died from disease 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 relapses produces excellent longterm results without the adverse effects associated with retroperitoneal node dissection or elective chemotherapy for high-risk cases.