Compliance with follow-up for patients with stage 1 testicular germ cell tumour

Background: This study aimed to evaluate the compliance and loss-to-follow-up (LTFU) rate in patients with stage 1 testicular germ cell tumours (GCTs) on active surveillance protocol at a metropolitan health service in Melbourne, Australia. Methods: Patients with stage 1 testicular GCTs diagnosed between 30 June 2012 and 30 June 2018 were identified. Compliance of surveillance programme was classified into three groups: 'adequate', 'missed appointment(s)' or 'LTFU'. The LTFU rate was assessed using Kaplan-Meier methodology. Log-rank test was used for univariate analyses. Results: Forty-eight patients had stage 1 testicular GCTs during the 6-year period. Twenty-two (46%) of them were managed with active surveillance and 26 (54%) of them were given adjuvant therapy. Compliance with active surveillance was assessed as adequate in 12 (55%), missed appointment(s) in six (27%) and LFTU in four (18%). The LTFU rates in patients with active surveillance at 12, 24 and 36 months were 9%, 9% and 19%, respectively. The LTFU rate in patients with active surveillance was not significantly different from patients who received adjuvant therapy (hazard ratio 0.71 (95% confidence intervals 0.22, 2.30), P = 0.56). Three (14%) of the 22 patients managed with active surveillance had recurrence of disease, all of which occurred in the first 12 months, compared to two (8%) of the 26 patients who had adjuvant therapy. Conclusion: Active surveillance is a commonly utilized management option for stage 1 testicular GCTs, but has a LTFU rate of almost 20% that may limit its effectiveness. The recurrence rate was comparable to published literature.