Very Late Recurrence in Germ Cell Tumor of the Testis: Lessons and Implications.

Very late recurrence (LR), i.e., >5 years after initial presentation, occurs in about 1% of patients with germ cell tumors of the testis (TGCT) and is associated with poor prognosis.

We retrospectively reviewed the records of patients at the M. D. Anderson Cancer Center who developed LR > 5 years after their initial diagnosis of TGCT.

We identified 25 patients who developed LR between July 2007 and August 2020. The median age at the time of LR was 46 years (range, 29-61). Pathology of LR: somatic transformation to carcinoma or sarcoma-11, nonseminoma with yolk sac tumor or teratoma-11, nonseminoma without yolk sac tumor or teratoma-2, not available-1. With a median follow-up of 3.5 years, 68% of patients are alive 3 years after LR. Patients with prior post-chemotherapy consolidation surgery do not have statistically significant longer survival compared to patients who did not receive post-chemotherapy consolidation surgery, 83.3% vs. 60.8% at 3 years, respectively, p = 0.50.

Patients with LR > 5 years tend to harbor nonseminoma (with yolk sac tumor and or teratoma). Among these patients, a majority who did not undergo surgery to remove residual disease after chemotherapy developed somatic transformation and succumbed to their LR.

Cancers. 2022 Feb 23*** epublish ***

Joseph A Moore, Rebecca S Slack, Michael J Lehner, Matthew T Campbell, Amishi Y Shah, Miao Zhang, Charles C Guo, John F Ward, Jose A Karam, Christopher G Wood, Louis L Pisters, Shi-Ming Tu

Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA., Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA., Department of Internal Medicine, University of Texas Health Science Center, Houston, TX 77030, USA., Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA., Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA., Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.