Journal of Clinical Oncology, Vol 10, 1762-1768, Copyright © 1992 by American Society of Clinical Oncology
Medical Research Council prospective study of surveillance for stage I testicular teratoma. Medical Research Council Testicular Tumors Working Party
G Read, SP Stenning, MH Cullen, MC Parkinson, A Horwich, SB Kaye and PA Cook
Medical Research Council, London, United Kingdom.
PURPOSE: A prospective study of surveillance after orchidectomy alone in
patients with stage I nonseminomatous germ cell testicular tumor (NSGCT)
was performed to determine the relapse-free rate and to identify the
histologic criteria that predict for relapse. PATIENTS AND METHODS: Three
hundred ninety-six patients from 16 United Kingdom and one Norwegian
centers were entered onto the study between January 1, 1984 and October 1,
1987 of whom 373 were eligible for analysis. In a previous retrospective
study, we defined a prognostic index based on histologic criteria that
identified a group of patients with a high risk of relapse. This index was
based on the presence of venous and lymphatic invasion, undifferentiated
cells, and the absence of yolk sac elements in the primary tumor. RESULTS:
The 2-year actuarial relapse- free rate after orchidectomy was 75% (95%
confidence interval, 71% to 79%), and the rate at 5 years was 73%. Five
patients died of tumor or treatment-related complications, which resulted
in a 5-year survival of 98%. The relapse-free rate in patients with three
or four risk factors was 54%. CONCLUSIONS: This study confirms the safety
of surveillance as a method of management and identifies a group of
patients with a high risk of relapse. A prospective phase II study has been
initiated to determine whether two courses of platinum-based adjuvant
chemotherapy will prevent relapse in these high-risk patients.
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