Introduction
The optimal treatment for patients with stage 1 non-seminoma germ cell tumour (NSGCT) following orchidectomy remains controversial. Adjuvant chemotherapy, surveillance and retroperitoneal lymph node dissection are each considered to be appropriate options post-orchidectomy. High risk features (lymphovascular invasion, predominance of an embryonal component and pathological stage ≥T2) are predictors for recurrence, and chemotherapy may be preferentially recommended. We correlated post-orchidectomy treatment decisions with histo-pathological parameters in patients with stage I NSGCT.

Methods
Clinical and pathological variables on patients treated between January 2005 and June 2012 were tabulated by retrospective chart review. Follow up for surveillance was conducted every month for the first year, every two months in the second year; every three months in the third year, and annual visit in the forth and fifth years. Clinical examination and analysis of tumour markers were performed at each visit. Non-compliance for patients undergoing surveillance was defined as missing three consecutive follow up clinics. Associations of predictors with choice of management were analysed by logistic regression, with statistical significance ascribed to p-values <0.05.

Results
Thirty-two patients of median age (range) 26.5 (17-40) years were studied, with 20 (62.5%) undergoing surveillance and 12 (37.5%) chemotherapy (cisplatin/etoposide). Five (16%) patients under surveillance and none having chemotherapy were non-complaint to follow up. With a median follow up of 48 months, two (6%) patients had relapsed at a median interval of 7.4 months. One recurred in the retroperitoneal lymph nodes, the other in the lung. Both these patients were in the surveillance program, and one was in fact non-compliant to follow up. On univariate analysis, patients with raised tumour markers preoperatively and lack of lymphovascular invasion were more likely to undergo surveillance (table 1). On multivariate analysis, alpha fetoprotein (AFP) was confirmed as a predictive variable for receiving surveillance.

Conclusions
The majority of patients with stage 1 NSGCT undergo surveillance after orchidectomy in our practice. Outcomes appear comparable between chemotherapy and surveillance groups. Patients who had raised AFP pre-operatively were less likely to receive chemotherapy.

Table 1: Univariate analysis of factors predictive of receiving adjuvant chemotherapy

 Abbreviations: OR, odds ratio; CI, confidence interval; AFP, alpha-feto protein; BHCG, B human chorionic gonadotropin; LVI, lymphovascular invasion