Excellent outcome in patients with stage I germ cell tumors of the testes: A study of the Children's Cancer Group/Pediatric Oncology Group

Marc Schlatter, Fred Rescorla, Roger Giller, Barbara Cushing, Charles Vinocur, Paul Colombani, John Cullen, Wendy London, Mary Davis, Stephen Lauer, Thomas Olson, T. Tracy, H. Snyder, R. Shamberger

Research output: Contribution to journalArticle

70 Scopus citations

Abstract

Background/Purpose: The aim of this study was to correlate outcomes in patients with stage I testicular germ cell tumors with compliance to surgical guidelines and to confirm previous single-institution experiences that show excellent disease-free survival rates when treated with orchiectomy alone. Methods: Sixty-three patients were entered into this intergroup study (Children's Cancer Group 8881/Pediatric Oncology Group 9048) between 1990 and 1996. Surgical guidelines for orchiectomy included an inguinal approach, early vascular control of the cord structures, and a hemiscrotectomy if a transscrotal violation occurred. Failure of tumor marker normalization or subsequent elevation suggested advanced disease requiring further surgery and chemotherapy. Survival curves were compared using the log-rank test. Results: The median age was 16 months (range, 1 month to 5.6 years). Progression of disease occurred in 11 patients. The 6-year event-free survival (EFS) was 78.5% ± 7%. The overall 6-year survival rate was 100%. Adherence to all guidelines was confirmed in only 43 patients (69%). Overall, there was no statistical significance in event-free survival rates between patients who had a correct surgical approach and all patients who had surgical violations; however, 4 patients with transscrotal violations showed a significantly higher rate of disease recurrence. Conclusions: Patients with stage I germ cell tumors of the testes have excellent survival rates when treated with surgery alone. Despite numerous surgical guideline violations, event-free survival in this multiinstitutional study was similar to previous single-institution reports. All patients with relapse or progression of their disease appear to be cured with further surgical excision and chemotherapy.

Original languageEnglish (US)
Pages (from-to)319-324
Number of pages6
JournalJournal of pediatric surgery
Volume38
Issue number3
DOIs
StatePublished - Mar 1 2003
Externally publishedYes

Keywords

  • Germ cell surgical guidelines
  • Germ cell tumors
  • Scrotal violation
  • Testicular cancer
  • Yolk sac tumors

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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