Testis conservation studies in germ cell cancer justified by improved primary chemotherapy response and reduced delay, 1978-1994.
Oliver RT., Ong J., Blandy JP., Altman DG.
OBJECTIVE: To investigate the need for the continued encouragement of early diagnosis of germ cell cancer of the testis, in view of the prevailing cure rate of 95%. PATIENTS AND METHODS: The study comprised a retrospective review of 453 unselected and previously untreated patients referred to one centre between 1978 and 1984, comparing the delay from first symptoms with the histological diagnosis. RESULTS: With a delay of < 30 days, 20% of patients had overt metastases at presentation and if the delay was > 4 months. 55% had metastases (chi-squared trend = 15.9, P < 0.001); 18% of Stage-1 patients under surveillance with a delay of < 30 days relapsed, compared with 38% of those with a delay of > 4 months. During the period 1978-1983, 16% of patients were seen after a delay of < 60 days, during the period 1984-1988 the proportion was 22% and during 1989-1994, 31% (chi-squared trend = 8.2, P < 0.004). There was a non-significant trend for a more prolonged delay in those aged < 21 years and > 40 years. Thirty-two patients had chemotherapy with the primary tumour in situ; at orchidectomy, 13 of 18 had no viable malignancy and four of five with viable malignancy also had drug-resistant metastases. Fourteen did not undergo orchidectomy; within a median follow-up of 9 years, one developed a second (histologically different) tumour after 12 years. The outcome of preliminary attempts to use neoadjuvant chemotherapy with or without partial orchidectomy for patients with tumours in a solitary testis is discussed. CONCLUSION: These findings clearly justify the continued encouragement of early diagnosis, possibly best performed as part of an extended educational programme of genital health at puberty. The long-term potential for testis conservation should be explored initially in tumours in a solitary testis.