One hundred and thirteen patients with non-seminoma testis and without clinical evidence of distant metastasis (category M0) have been analyzed with regard to the risk of subsequent metastasis after subdiaphragmatic irradiation. Important prognostic factors were: histology (malignant teratoma intermediate (MTI), malignant teratoma undifferentiated (MTU), T-category (T4, T less than 4), clinical regional and juxta-regional subdiaphragmatic lymph node involvement (N0, N1,2, N3,4) and vascular invasion in the orchidectomy specimen (V-, V+). If vascular invasion was considered, the histological type MTI or MTU lost its prognostic impact. Categories T4 and N greater than or equal to 1 worsen prognosis and if vascular invasion could be observed metastasis-risk would be additionally increased. Watch-and-wait policy is probably most justified in categories T less than 4, N0, V-. Elective chemotherapy might be most justified in categories T4N0V+ and T less than 4N greater than or equal to 1V+.
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