Differential therapeutic approach in patients with clinical stage of nonseminomatous germ cell testicular tumors: long-term experience

Background: Surveillance after orchiectomy alone has become popular for the management of clinical stage I nonseminomatous germ cell tumors of the testis (CS I NSGCTT). Efforts to identify patients at high risk of relapse has led to a search for prognostic factors of CS I NSGCTT. The aim of this study was to analyse long-term experiences with different therapeutic approaches in CS I NSGCTT patients according to relapse risk factors. Methods: From 2/1992 to 5/2008, a total of 352 CS I NSGCTT patients were included in the study and stratified into different risk-adapted therapeutic approaches (groups 1-3). 114 patients (group 1) with vascular invasion andmajority of embryonal carcinoma component in the primary tumor were treated with 2 cycles of BEP chemotherapy. Results: Relapse was experienced in 2 patients (1.75 %). Among 12 patients (group 2) with vascular invasion and majority of teratomatous elements in the primary tumor undergoing primary retroperitoneal lymph node dissection (RPLND), 10 were found to be in pathological stage I. Relapse was observed in two patients (16.7 %), one of whom died 29 months following orchiectomy. Two patients (18.2 %) with pathological stage II received adjuvant chemotherapy and finally died. 226 patients (group 3) without vascular invasion were followed after orchiectomy. Relapse was observed in 41 patients (18.1 %). They were treated with BEP chemotherapy, of whom three died. The overall survival rate of all the patients in group B1-3 was 98.3 %. Conclusions: Surveillance procedure is recommend only in patients without vascular invasion in the primary tumor.