[疾病进展的预后因素在Ⅰ期非精原细胞瘤性睾丸肿瘤患者治疗中的应用]

[Use of prognostic factors of disease progression in the treatment of patients with stage I nonseminomatous testicular tumors].

作者信息

Ondrus D

机构信息

Urologická klinika, Lekárskej fakulty, Univerzity Komenského v Bratislave.

出版信息

Bratisl Lek Listy. 1999 Jan;100(1):61-5.

PMID:10493000

Abstract

BACKGROUND

Surveillance after orchiectomy alone becomes popular for the management of CS I NSGCTT. Effort to identify patients at high risk of relapse leads to searching for prognostic factors of CS I NSGCTT.

OBJECTIVES

The aim of this study was to identify those patients in whom surveillance policy is less likely to be successful.

METHODS AND RESULTS

95 CS I NSGCTT patients were stratified to different risk-adapted therapeutic approaches according to histopathologic findings of primary tumor removed by inguinal orchiectomy. Twenty nine patients (group A) with vascular invasion and majority of embryonal carcinoma component in the primary tumor were treated with adjuvant BEP chemotherapy. Disease progression was experienced in one patient (3.4%) 19 months of follow-up. Other 28 patients live without evidence of disease (NED) with a mean follow-up period of 31.1 months after orchiectomy. Six patients (group B) with vascular invasion and majority of teratomatous elements in the primary tumor have been followed 52.7 months after orchiectomy in average. They were treated with primary retroperitoneal lymph node dissection (RPLND). Two of them (33.3%) had pathologic stage II after RPLND and underwent subsequent chemotherapy. The progression of disease was observed in one patient (16.7%) who died 29 months following orchiectomy, another 5 patients live with NED. Sixty patients (group C) without vascular invasion have been followed for 40.6 months in average after orchiectomy. They were kept under close surveillance, consisted of regular follow-up with tumor markers, chest x-ray and CT of the retroperitoneum. Disease progression was observed in 11 (18.3%) patients after a mean duration of 11.8 months after orchiectomy. They were treated with BEP chemotherapy. All of them live with NED (five of them need postchemotherapy RPLND) with mean duration of follow-up 24.8 months after treatment. The overall survival rate of all 95 patients was 98.9% with mean duration of 38.5 months (range, 2-83+).

CONCLUSIONS

Surveillance policy is recommend only in patients without vascular invasion in the primary tumor. (Fig. 1, Ref. 32.)

摘要

背景

单纯睾丸切除术后的监测在I期非精原细胞瘤性生殖细胞肿瘤（NSGCTT）的管理中变得流行起来。为了确定复发风险高的患者，人们努力寻找I期NSGCTT的预后因素。

目的

本研究的目的是确定那些监测策略不太可能成功的患者。

方法与结果

根据腹股沟睾丸切除术切除的原发性肿瘤的组织病理学结果，将95例I期NSGCTT患者分层为不同的风险适应性治疗方法。29例（A组）原发性肿瘤有血管侵犯且主要为胚胎癌成分的患者接受了辅助性BEP化疗。1例患者（3.4%）在随访19个月时病情进展。其他28例患者无疾病证据（NED）存活，睾丸切除术后平均随访期为31.1个月。6例（B组）原发性肿瘤有血管侵犯且主要为畸胎瘤成分的患者，睾丸切除术后平均随访52.7个月。他们接受了原发性腹膜后淋巴结清扫术（RPLND）。其中2例（33.3%）RPLND术后病理分期为II期，并接受了后续化疗。1例患者（16.7%）在睾丸切除术后29个月死亡，观察到疾病进展，另外5例患者无疾病存活。60例（C组）无血管侵犯的患者，睾丸切除术后平均随访40.6个月。他们接受密切监测，包括定期随访肿瘤标志物、胸部X光和腹膜后CT。11例（18.3%）患者在睾丸切除术后平均11.8个月出现病情进展。他们接受了BEP化疗。所有患者均无疾病存活（其中5例需要化疗后RPLND），治疗后平均随访期为24.8个月。95例患者的总生存率为98.9%，平均生存期为38.5个月（范围，2 - 83 +）。