睾丸临床I期非精原细胞性生殖细胞肿瘤睾丸切除术后的观察结果。

Observations after orchiectomy in clinical stage I nonseminomatous germ cell tumors of the testis.

作者信息

Kuo J Y, Chin T, Hsieh Y L, Lin A T, Chang Y H, Wei C, Chen K K, Chang L S

机构信息

Department of Surgery, Veterans General Hospital-Taipei, Taiwan, ROC.

出版信息

Zhonghua Yi Xue Za Zhi (Taipei). 1999 Jun;62(6):356-61.

PMID:10389293

Abstract

BACKGROUND

The optimal management of clinical stage I nonseminomatous germ cell tumor (NSGCT) of the testis remains controversial. For years, retroperitoneal lymph node dissection in combination with orchiectomy, has been the standard treatment in patients with clinical stage I NSGCT. Recently, with advancement of effective cisplatin-based chemotherapy and clinical staging procedures, a new approach of observation after orchiectomy is being evaluated. We reviewed cases of orchiectomy and observation for clinical stage I NSGCT of the testis in order to evaluate the treatment outcome.

METHODS

We retrospectively reviewed the records of 13 patients with clinical stage I NSGCT of the testis treated at our hospital from February, 1981 to August, 1996. The patient age at diagnosis ranged from 0.6 to 44 years. Nine patients had yolk sac tumors, and four had mixed germ cell tumors. Median follow-up was 42 months (range, 20-132 months).

RESULTS

Prior to orchiectomy, serum beta-human chorionic gonadotropin and alpha-fetoprotein (AFP) were raised to abnormal concentrations in four and in 13 patients, respectively. With a median follow-up of 42 months, three of 13 patients relapsed at a median of three months after orchiectomy. Two patients showed elevated AFP and radiographically identifiable tumors simultaneously, and one patient showed elevated AFP as the only evidence of relapse. Following treatment with cisplatin-based chemotherapy, the three patients who relapsed responded successfully and the elevated AFP returned to normal. The patients are currently alive and disease free.

CONCLUSIONS

Observation after orchiectomy is a reasonable approach for patients with clinical stage I NSGCT of the testis.

摘要

背景

睾丸临床I期非精原细胞瘤（NSGCT）的最佳治疗方案仍存在争议。多年来，腹膜后淋巴结清扫术联合睾丸切除术一直是临床I期NSGCT患者的标准治疗方法。最近，随着基于顺铂的有效化疗和临床分期程序的进展，一种睾丸切除术后观察的新方法正在接受评估。我们回顾了睾丸临床I期NSGCT的睾丸切除术及观察病例，以评估治疗结果。

方法

我们回顾性分析了1981年2月至1996年8月在我院接受治疗的13例睾丸临床I期NSGCT患者的记录。诊断时患者年龄在0.6岁至44岁之间。9例患者患有卵黄囊瘤，4例患有混合性生殖细胞肿瘤。中位随访时间为42个月（范围20 - 132个月）。

结果

在睾丸切除术前，分别有4例和13例患者的血清β-人绒毛膜促性腺激素和甲胎蛋白（AFP）升高至异常浓度。中位随访42个月，13例患者中有3例在睾丸切除术后中位3个月复发。2例患者同时出现AFP升高和影像学可识别的肿瘤，1例患者仅表现为AFP升高作为复发的唯一证据。在接受基于顺铂的化疗后，3例复发患者成功缓解，升高的AFP恢复正常。这些患者目前存活且无疾病。