Clinical outcomes in patients with stage I non-seminomatous germ cell cancer

Abstract

This study assesses the long-term outcomes in Han Chinese patients with clinical stage I non-seminomatous germ cell testicular cancer (CSI NSGCT) treated with surveillance, retroperitoneal lymph node dissection (RPLND) and adjuvant chemotherapy. We retrospectively evaluated 89 patients with a mean age of 26.5 years. After orchiectomy, 37 patients were treated with surveillance, 34 underwent RPLND and 18 were managed with chemotherapy. The overall survival rate, the recurrence-free survival rate and the risk factors were evaluated. The median follow-up length was 92 months (range: 6-149 months). Thirteen of the 89 patients (14.6%) had relapses, and one died by the evaluation date. The overall survival rate was 98.9%. The cumulative 4-year recurrence-free rates were 80.2%, 92.0% and 100% for the surveillance, RPLND and chemotherapy groups, respectively. The disease-free period tended to be briefer in patients with a history of cryptorchidism and those with stage Is. Therefore, surveillance, RPLND and adjuvant chemotherapy might be reliable strategies in compliant patients with CSI NSGCT. Surveillance should be recommended for patients with the lowest recurrence rate, especially those without lymphovascular invasion. This study might aid the establishment of a standard therapy for CSI NSGCT in China.

Figure 1

Treatment algorithm after orchiectomy according to individual risk factors in patients with clinical stage I non-seminomatous germ cell tumours. High risk: vascular invasion or lymphatic invasion; low risk: none vascular invasion and none lymphatic invasion. DOD: died of disease; ER: evidence of recurrence; NER: no evidence of recurrence; RPLND: retroperitoneal lymph node dissection.

Figure 2

The overall survival curve of CSI NSGCT (89 patients). CSI NSGCT, clinical stage I non-seminomatous germ cell testicular cancer.

Figure 3

Recurrence-free survival for patients with CSI NSGCT treated with surveillance, RPLND and adjuvant chemotherapy. CSI NSGCT, clinical stage I non-seminomatous germ cell testicular cancer; RPLND, retroperitoneal lymph node dissection.

Figure 4

Recurrence-free survival for six patients with history of cyptorchidism and 83 patients without history of cryptorchism.

Figure 5

Recurrence-free survival for all patients of primary tumour stages Ia, Ib and Is.