The outcome differences between late and early relapses after orchiectomy (OE) in patients (pts) with stage I germ cell tumors (GCT).

Abstract

e15013 Background: Late relapses (>2 years) after completion of chemotherapy are rare and often platinum-resistant. There are limited data concerning late relapses in chemotherapy-naïve pts with stage I GCT. This retrospective analysis was performed to compare the outcome between pts with stage I GCT, who had late (≥2 years) and early (≥3 months and < 2 years) relapse after OE. Methods: We analyzed data of 1069 CT-naïve pts with advanced GCT of testis treated in our department from 1986 to 2008. All pts had cisplatin- and etoposide-based CT. We identified 169 (15.8%) pts with prior stage I disease, who had not received adjuvant treatment: 140 and 29 pts had early and late relapse, respectively. Among pts with late relapse pure seminoma was revealed in 14 pts, nonseminoma – in 15 pts. Median f.-up time for 169 pts was 35 (range, 2 - 218) months. Results: Pts with late relapse were older – 35 years (23-57), whereas pts with early relapse – 30 years (16-63) (p=0.0008) and also had more frequent pure seminoma in primary tumor: 14/29 (48,3%) vs. 46/140 (32,8%), p=0.08. At the time of disease progression both groups were very similar according to well-known prognostic factors incl. IGCCCG classification. The only difference between groups was larger size of retroperitoneal lymph nodes in late (9 cm) than in early relapse (4 cm, p<0.0001). The outcome in pts with late relapse was significantly worse than in pts with early relapse: complete response rate after induction CT was 20.7% (6/29) vs. 42.1% (59/140) (p=0.01), three-year PFS - 70% vs. 84% (p=0.05, HR 2.1, 95%CI 1.0-7.6) and three-year OS - 72% vs. 88% (p=0.04, HR=2.4 95% CI 1.05-10.25), respectively. In pts with pure seminoma this difference in OS was even more significant: 65% vs. 91% (p=0.04, HR=3.8, 95%CI=1.06-32.4). Conclusions: Late relapse following stage I GCT was associated with seminoma, older age and worse outcome after induction CT.