Late Relapse of Germ Cell Tumors After Prior Chemotherapy or Surgery-only

Testicular germ cell tumor late relapse is a rare and under-recognized phenomenon. We evaluated 131 late relapse patients at Indiana University. A prior history of chemotherapy before late relapse had inferior outcomes compared to chemotherapy naive patients. Life-long follow-up in chemotherapy-exposed patients with annual examination and tumor markers is recommended as majority of late relapses had an elevated tumor marker. Background: Late relapse (LR) of germ cell tumor (GCT) is defined as relapsed disease > 2 years from initial treatment. LR remains a challenge both for optimal screening methods and management. We report the method of detection, treat-ments received, and outcomes in patients with chemotherapy-exposed vs chemotherapy-naive LR GCT. Patients and Methods: The Indiana University testicular cancer database was queried identifying 131 patients with LR GCT evalu-ated at Indiana University from January 2000 to January 2019. Method of detection of LR was recorded along with site, treatment received, and survival outcomes. The cohort was divided into 4 groups according to seminoma versus non-seminoma GCT (NSGCT) and chemotherapy-exposed vs chemotherapy-naive LR. Progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan-Meier method and compared using the log-rank test. Medians with 95% confidence intervals were also calculated along with the 2-year probabilities. Results: Median age at LR was 38.3 (range, 19.3-56.8). Chemotherapy-exposed accounted for 75 (57%) and chemotherapy-naive for 56 (43%) of cases. The 2-year OS comparing chemotherapy-exposed versus chemotherapy-naive was 78.2% versus 100% ( P = .0003). For the 72 chemo-exposed NSGCT LR pts, 2-year PFS based on treatment: surgery vs chemotherapy versus surgery + chemotherapy was 67.1% versus 0% versus 47.1% ( P < 0.0001). Fifty-nine percent of chemotherapy-exposed LR had elevation of alpha fetoprotein (AFP) at LR diagnosis. Conclusion: GCT pts require lifetime follow-up with annual physical exam and tumor markers. Surgical resection, when feasible, remains the preferred treatment for chemotherapy-exposed LR. Chemotherapy-exposed LR has worse outcomes compared to chemotherapy-naive LR patients.