The first report from Indiana University [6] included 81 patients who were diagnosed with late-relapse GCT from 1979 to 1992. Although the true incidence of late relapse could not be calculated because many of the patients were referrals who were initially treated outside the university center, the incidence could be deducted by limiting the study population to men with stage II/III tes-ticular cancer who entered first-line chemotherapy protocols at Indiana University. This analysis yielded 17 men with late relapse out of a total of 590 men treated for primary GCT during the study period (2.9%). Accordingly, data from Memorial Sloan-Kettering Cancer Center (MSKCC) showed a 3% rate of GCT relapse at 2 years after receipt of first-line chemotherapy for viable GCT, for an incidence of 3.1 per 1000 years of follow-up [7]. Similar rates ranging from 2.3% to 4.3% have been reported from European centers [8-10].

Late relapse of stage I GCT has also been described. Studies of surveillance programs [1116] comprising a total of 1419 patients with stage

I GCT patients managed by orchiectomy and active surveillance recorded an overall late relapse rate of 1.9%. Similar rates were observed among seminomatous and nonseminomatous GCT.

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