Diagnostic delay and risk of relapse in patients with stage I nonseminomatous germ cell tumour followed on active surveillance.

Abstract

To determine whether delayed diagnosis affects the outcome of patients with stage I nonseminomatous germ cell tumour (NSGCT) followed by a policy of 'active surveillance'. A series of 185 consecutive patients with either low-risk (no vascular invasion) or unknown risk stage I NSGCT referred to Mount Vernon Hospital between 1983 and 1998 were analysed retrospectively for the type and duration of symptoms before orchidectomy, time to relapse, and for site and stage of relapse. Twenty-six patients (14%) relapsed within a medium follow-up of 98 months. The median (range) time to relapse was 4 (1-14) months. All patients were effectively salvaged with chemotherapy and in some by surgery. The median duration of symptoms before orchidectomy for those patients relapsing was 2 months, and not significantly different from those who did not relapse. In patients with stage I NSGCT the duration of symptoms before diagnosis did not influence the probability of relapse.