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Surgery and observation (stage I)
Source: Childhood Extracranial Germ Cell Tumors Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: November 5, 2024 · Captured 2026-09-09.
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Surgery and close follow-up observation are indicated to document that tumor marker levels normalize after resection.[3,9]
Evidence (surgery and observation for stage I disease in prepubertal males):
A Children’s Cancer Group (CCG)/Pediatric Oncology Group (POG) clinical trial evaluated surgery followed by observation for boys aged 10 years or younger with stage I testicular tumors.[3,4]
A Children’s Cancer Group (CCG)/Pediatric Oncology Group (POG) clinical trial evaluated surgery followed by observation for boys aged 10 years or younger with stage I testicular tumors.[3,4]
This treatment strategy resulted in a 6-year event-free survival (EFS) rate of 82%.
A Children’s Cancer Group (CCG)/Pediatric Oncology Group (POG) clinical trial evaluated surgery followed by observation for boys aged 10 years or younger with stage I testicular tumors.[3,4]
Boys who developed recurrent disease received salvage therapy with four cycles of standard-dose cisplatin, etoposide, and bleomycin (PEb), with a 6-year survival rate of 100%.
A subsequent Children’s Oncology Group (COG) study of 80 boys younger than 15 years with stage I disease included 15 boys aged 11 to 15 years who were treated with surgery and observation.[10][Level of evidence C1]
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A subsequent Children’s Oncology Group (COG) study of 80 boys younger than 15 years with stage I disease included 15 boys aged 11 to 15 years who were treated with surgery and observation.[10][Level of evidence C1]
The 4-year EFS rate was 80% for the 65 boys younger than 11 years at diagnosis and 48% for the 15 boys aged 11 years and older (P < .01). All patients' disease was eventually salvaged, with a 4-year overall survival (OS) rate of 100%.
A subsequent Children’s Oncology Group (COG) study of 80 boys younger than 15 years with stage I disease included 15 boys aged 11 to 15 years who were treated with surgery and observation.[10][Level of evidence C1]
Favorable prognostic factors were younger age, presence of pure yolk sac tumor, and lack of lymphovascular invasion by the primary tumor.
A subsequent Children’s Oncology Group (COG) study of 80 boys younger than 15 years with stage I disease included 15 boys aged 11 to 15 years who were treated with surgery and observation.[10][Level of evidence C1]
Adult testicular staging systems classify patients with lymphovascular invasion as stage IB. In the entire cohort, those with lymphovascular invasion had a lower 4-year EFS rate (62% vs. 84%).
A pooled analysis (from the studies above) provided more complete outcome data on patients with stage I disease who were treated with surgery and observation.[11][Level of evidence C2]
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A pooled analysis (from the studies above) provided more complete outcome data on patients with stage I disease who were treated with surgery and observation.[11][Level of evidence C2]
Most patients were prepubertal, but 13.2% of patients were adolescents (aged 13–15 years).
A pooled analysis (from the studies above) provided more complete outcome data on patients with stage I disease who were treated with surgery and observation.[11][Level of evidence C2]
At a median follow-up of 56 months, all patients were alive.
A pooled analysis (from the studies above) provided more complete outcome data on patients with stage I disease who were treated with surgery and observation.[11][Level of evidence C2]
There were 25 events.
A pooled analysis (from the studies above) provided more complete outcome data on patients with stage I disease who were treated with surgery and observation.[11][Level of evidence C2]
On multivariate analysis, independent prognostic factors were age younger than 12 years (hazard ratio [HR], 8.87; P < .0001) and higher pT stage (pT2: HR, 7.31; P = .0017 and pT3: HR, 13.5; P = .0047).
A German study (MAHO 98) of 128 boys younger than 10 years with testicular GCTs, mostly stage I, also evaluated surgery followed by observation.[12][Level of evidence C1]
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A German study (MAHO 98) of 128 boys younger than 10 years with testicular GCTs, mostly stage I, also evaluated surgery followed by observation.[12][Level of evidence C1]
There were 49 patients with yolk sac tumors that were staged as IA after inguinal orchiectomy. Stage IA includes no evidence of lymphovascular invasion. The 5-year EFS rate was 95%, and the 5-year OS rate was 100% for this group. Two patients relapsed and then were cured after chemotherapy.
A German study (MAHO 98) of 128 boys younger than 10 years with testicular GCTs, mostly stage I, also evaluated surgery followed by observation.[12][Level of evidence C1]
There were 12 patients who initially had trans-scrotal orchiectomy who were pathologically confirmed to have no lymphovascular invasion (would be considered stage IA, if not for surgery). Ten patients were observed who had no adverse events. Two patients relapsed (17%) and remained in continuous remission after chemotherapy. No patients had hemiscrotectomy. A long-standing question has been whether trans-scrotal orchiectomy necessitates chemotherapy or hemiscrotectomy.
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Preserved source evidence · Not medical advice