Surveillance following orchidectomy for stage I testicular cancer

Surveillance following orchidectomy was introduced in the management of Stage I testicular nonseminoma in 1979 and Stage I seminoma in 1983. Of 132 nonseminoma patients followed for 12-84 months (median 43 months) the relapse rate is 27%. Relapses were diagnosed 2-44 months after orchidectomy with 90% of relapses appearing within the first year. Of the 132 patients, 131 are alive and disease-free. The pattern of relapse was as follows: 47% of relapses occurred in abdominal nodes, 13% in abdominal nodes and lung, 17% in the lung and 23% with elevated serum markers as the only evidence of disease; 26% of relapsing patients had normal serum AFP and hCG levels. The prognostic significance of thirteen clinical histopathological and biochemical factors has been analysed by multiple regression analysis. Histology and lymphatic invasion within the primary tumour are significant independent prognostic factors. A total of thirty-six patients had scrotal interference prior to removal of the primary tumour. This was not a contra-indication to surveillance. None has developed scrotal recurrence and the overall relapse rate (11%) is comparable to that observed in the surveillance series as a whole. Fifty-two patients with Stage I seminoma have been observed from 12-41 months after orchidectomy. Seven (13%) have relapsed and six of the seven relapses have been confined to retroperitoneal lymph nodes. Preliminary data suggests that pre-orchidectomy elevation of serum hCG is not a significant prognostic factor.