{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T15:53:57Z","timestamp":1776959637793,"version":"3.51.4"},"reference-count":16,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"34","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCO"],"published-print":{"date-parts":[[2008,12,1]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p> Late relapse (LR) of germ cell tumor (GCT) is a well recognized entity associated with poor survival. We report on our experience with LR and determine predictors of survival. <\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p> From 1990 to 2004, 75 patients were managed for LR of GCT at our institution. Clinical and pathologic parameters were reviewed. Estimates of cancer-specific survival were generated using the Kaplan-Meier method, and a Cox proportional hazards model was used to assess potential predictors of outcome. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> The median time to LR was 6.9 years (range, 2.1 to 37.7 years). Overall, 56 patients (75%) had LR in the retroperitoneum, including 25 (93%) of 27 patients initially managed without retroperitoneal lymph node dissection. The 5-year cancer-specific survival (CSS) was 60% (95% CI, 46% to 71%). Patients who underwent complete surgical resection at time of LR (n = 45) had a 5-year CSS of 79% versus 36% for patients without complete resection (n = 30; P &lt; .0001). The 5-year CSS for chemotherapy-naive patients was significantly greater than patients with a prior history of chemotherapy as part of their initial management (5-year CSS, 93% v 49%, respectively). In multivariable analysis of pretreatment parameters available at the time of LR, the presence of symptoms (hazard ratio [HR] = 4.9) and multifocal disease (HR = 3.0) were associated with an inferior CSS. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p> The data suggest that meticulous control of the retroperitoneum is critical to prevent LR in the retroperitoneum. In multivariable analysis, patients with a symptomatic presentation and those with multifocal disease have a significantly decreased survival. Survival is greatly improved if complete surgical excision of disease is attained. <\/jats:p><\/jats:sec>","DOI":"10.1200\/jco.2007.15.7453","type":"journal-article","created":{"date-parts":[[2008,10,21]],"date-time":"2008-10-21T01:31:48Z","timestamp":1224552708000},"page":"5524-5529","source":"Crossref","is-referenced-by-count":101,"title":["Clinical Outcome and Predictors of Survival in Late Relapse of Germ Cell Tumor"],"prefix":"10.1200","volume":"26","author":[{"given":"David S.","family":"Sharp","sequence":"first","affiliation":[{"name":"From the Departments of Urology and Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brett S.","family":"Carver","sequence":"additional","affiliation":[{"name":"From the Departments of Urology and Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott E.","family":"Eggener","sequence":"additional","affiliation":[{"name":"From the Departments of Urology and Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G. 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