Late, Very Late Relapses Less Common with Modern Testicular Cancer Treatments

A new population-based analysis has found that the rate of very late relapses, occurring after a 5-year disease-free survival, is low among patients with testicular cancer treated according to modern guidelines.

Torgrim Tandstad, of St. Olav’s University Hospital, Trondheim, Norway, and colleagues presented these results at the 2022 ASCO Annual Meeting (Abstract 5008).

According to the study abstract, data on the rate of late relapse – occurring after two years of disease-free survival – and very late relapse are scarce and “hampered by selection bias and incomplete data regarding follow-up.”

Tandstad and colleagues wanted to investigate the frequency of late relapses and very late relapses and survival in these patients looking at those treated after 1995, and comparing them with those treated before 1995.

The study included 5,712 patients diagnosed with testicular cancer in Norway; 2,207 were diagnosed from 1980-1995 and 5,712 were diagnosed from 1995-2009. According to the researchers, data are complete due to identification by the Cancer Registry of Norway and Norwegian Cause of Death Registry.

Of the included patients, 472 experienced relapse: 186 were seminoma and 286 were nonseminoma. Of the relapses, 109 were considered late relapses and 50 were very late relapses. Seventeen relapses were beyond 10 years.

Median time to late relapse was 4.7 years. In patients with clinical stage I disease, the rate of relapse was 7.9%, late relapse 1.9%, very late relapse 1.0%, and 0.5% beyond 10 years.

There was a higher rate of late relapse in patients followed with surveillance as compared with those who underwent adjuvant therapy (4.0% vs. 1.0%).

Among patients with metastatic disease, 10.5% had disease relapse. Late relapse occurred in 3.6% of patients, very late relapse in 1.6%, and relapse beyond 10 years in 0.8%.

The very late relapse rate in patients with nonseminoma was 0.8% for those diagnosed after 1995 compared with 2.3% for those diagnosed earlier.

The researchers concluded that “centralization of treatment, adherence to guidelines, prospective registration of patients, and subsequent reporting of results are key to these improved results.”