Testicular germ cell tumors Gels

A wait-and-see policy for patients with stage I nonseminomatous testicular germ cell tumors (NSTGCT) was evaluated in a prospective study. The frequency and time of recurrence, detection of recurrence and presence of unfavourable prognostic factors were investigated. During the period 1982 to 1992, 154 patients with stage I NSTGCT (median age 29 years) underwent orchidectomy and were monitored at follow-up evaluation with physical examinations, alphafetoprotein (AFP) and human chorionic gonadotrophin (hCG) levels, chest X-rays (CXR) and computed tomography (CT) scans of the abdomen and chest. Multivariate logistic regression analyses were performed to identify prognostic factors. During a median follow-up period of 7 years (range 2-12), recurrence was found in 42 patients (27.3%). All cases of recurrence were detected within two years, 90% in the first year after orchidectomy. In 29 patients (69.0%), recurrence was detected in the abdominal lymph nodes. Nine patients (21.4%) had metastases in the retroperitoneum and the mediastinum and/or the lungs and four patients (9.6%) had metastases only in the mediastinum or lungs. The majority of recurrences (97.6%) were detected by tumor markers and CT scans. Recurrence was related to the presence of vascular invasion, embryonal carcinoma (E), an elevated preoperative hCG level and the absence of mature teratoma (M). Only vascular invasion was an independent risk factor. After polychemotherapy treatment for recurrence, the survival rate in the total group was 98.7%. The wait-and-see policy is a reliable method for follow-up monitoring of patients with stage I NSTGCT. Even in patients with unfavourable prognostic factors, it is justified to await the possible appearance of metastases. For the future it is recommended that CXR be omitted from the schedule, and it might be feasible to discontinue the follow-up evaluations after five years.