How does the late recurrence of testicular germ cell tumors occur? What are the prognostic factors to predict the late recurrence?
Germ cell tumors (GCTs) have become a model in contemporary medicine for a curable cancer with a combination of modalities such as surgery and chemotherapy. Nevertheless, 7%–16% of the patients still relapse, and most recurrences are seen within the first year. Late recurrence (recurrence after two disease-free years) is rare, seen in about 4% of patients. The risk is related to the initial stage of GCT, high levels of serum markers, presence of embryonal carcinoma in the orchiectomy specimen, and teratoma remaining in the retroperitoneal lymph nodes after chemotherapy. Teratoma is the most common type found in tissue removed at late recurrence, followed by atypical yolk sac tumors. Other types may be found at a lesser frequency. Late relapse is rarely, if ever, cured by chemotherapy alone. Thus, primary management is surgical. In about one-fourth of cases, non-GCT malignancies, including various types of sarcoma and adenocarcinoma, are found. Recurrence with teratoma alone has the best outcome, with approximately 80% of patients with no evidence of disease at follow-up.
KeywordsGerm Cell Tumor Testicular Cancer Embryonal Carcinoma Late Recurrence Testicular Germ Cell Tumor
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