Does delayed diagnosis or scrotal incision affect outcome for men with non‐seminomatous germ cell tumours?

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Abstract
Objective To ascertain whether delayed diagnosis or type of orchidectomy affected outcome for men with non‐seminomatous germ cell tumours (NSGCT). Patients and methods The case notes of 454 men resident in the west of Scotland with a diagnosis of NSGCT between 1975 and 1989 were retrospectively reviewed. The clinical record was available for 442 (97%) and included information on time to diagnosis in 92% and diagnostic surgery in 97%. The study end‐point for orchidectomy was loco‐regional recurrence and for diagnostic delay was survival. Results A significant minority of men (10.4%) underwent a scrotal orchidectomy or had a scrotal incision before an inguinal orchidectomy (9.4%). More scrotal incisions were performed on patients under the care of general surgeons (28%) than of urologists (12.1%). Of the men who had scrotal surgery, one of 78 (1.3%; 95% CI, 0–4%) developed loco‐regional disease as the initial site of recurrence, compared with none of 318 men undergoing inguinal orchidectomy. The median time to diagnosis was 3 months. There was no relationship between time to diagnosis and tumour extent at presentation. A diagnostic delay of >3 months was associated with inferior survival in univariate analysis, but delayed diagnosis was not an independent influence on survival after adjustment for the major prognostic factors—tumour extent, year of diagnosis and treatment unit. Conclusions These results suggest that scrotal incision is unlikely to affect the risk of loco‐regional recurrence and that effective cytotoxic therapy has probably reduced the prognostic importance of delayed diagnosis on survival of men with NSGCT.