BACKGROUND: Very late recurrence (LR), i.e., >5 years after initial presentation, occurs in about 1% of patients with germ cell tumors of the testis (TGCT) and is associated with poor prognosis. METHODS: We retrospectively reviewed the records of patients at the M. D. Anderson Cancer Center who developed LR > 5 years after their initial diagnosis of TGCT. RESULTS: We identified 25 patients who developed LR between July 2007 and August 2020. The median age at the time of LR was 46 years (range, 29-61). Pathology of LR: somatic transformation to carcinoma or sarcoma-11, nonseminoma with yolk sac tumor or teratoma-11, nonseminoma without yolk sac tumor or teratoma-2, not available-1. With a median follow-up of 3.5 years, 68% of patients are alive 3 years after LR. Patients with prior post-chemotherapy consolidation surgery do not have statistically significant longer survival compared to patients who did not receive post-chemotherapy consolidation surgery, 83.3% vs. 60.8% at 3 years, respectively, p = 0.50. CONCLUSIONS: Patients with LR > 5 years tend to harbor nonseminoma (with yolk sac tumor and or teratoma). Among these patients, a majority who did not undergo surgery to remove residual disease after chemotherapy developed somatic transformation and succumbed to their LR.
Very Late Recurrence in Germ Cell Tumor of the Testis: Lessons and Implications