Shahidi Mehdi, Norman Andrew R, Dearnaley David P, Nicholls Judy, Horwich Alan, Huddart Robert A
Academic Department of Radiotherapy and Oncology, The Royal Marsden NHS Trust, Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom.
Cancer. 2002 Aug 1;95(3):520-30. doi: 10.1002/cncr.10691.
Testicular germ cell tumors are highly curable. However, 10-30% of patients have recurrence after initial treatment. The time-course of recurrence has implications for the duration of follow-up. This study was undertaken to assess the risk and time-course of recurrence and to identify patients at higher risk of late recurrence.
The records of 1263 patients with primary testicular germ cell tumors presenting to the Royal Marsden Hospital between December 1979 and December 1993 were reviewed. In all, 255 episodes of recurrence were documented (including 44 patients with multiple recurrences) and used to calculate recurrence-free survivals.
Fifty-three patients (15 seminomas; 38 nonseminomatous germ cell tumors [NSGCT]) had recurrence more than 2 years after initial presentation. A multivariate analysis of risk of recurrence after 2 years identified positive markers at presentation and the presence of differentiated teratomas in postchemotherapy surgical specimens as significant predictors. Very late recurrence (> 5 years) occurred mainly in patients with metastatic NSGCT (12 of 14 patients) with a 1% annual risk of recurrence between 5 and 10 years. Very late recurrence was also seen in one case of metastatic seminoma and one case of Stage I NSGCT managed by surveillance. Most late recurrences (n = 9) were detected at routine annual follow-up visits but five had recurrences with symptoms leading to an unscheduled clinic visit.
Late recurrences are rare in patients with testicular germ cell tumors and follow-up to detect recurrence may not be needed after 5 years, except in those presenting with metastatic NSGCTs.
睾丸生殖细胞肿瘤具有很高的治愈率。然而，10% - 30%的患者在初始治疗后会复发。复发的时间进程对随访时间有影响。本研究旨在评估复发的风险和时间进程，并识别晚期复发风险较高的患者。
回顾了1979年12月至1993年12月期间在皇家马斯登医院就诊的1263例原发性睾丸生殖细胞肿瘤患者的记录。共记录了255次复发事件（包括44例多次复发的患者），并用于计算无复发生存率。
53例患者（15例精原细胞瘤；38例非精原细胞性生殖细胞肿瘤[NSGCT]）在初次就诊后2年以上复发。对2年后复发风险的多因素分析确定，就诊时的阳性标志物以及化疗后手术标本中存在分化型畸胎瘤是显著的预测因素。极晚期复发（>5年）主要发生在转移性NSGCT患者中（14例患者中的12例），5至10年的年复发风险为1%。在1例转移性精原细胞瘤和1例接受监测的I期NSGCT患者中也观察到极晚期复发。大多数晚期复发（n = 9）在年度常规随访中被发现，但有5例因症状复发而进行了非计划的门诊就诊。
睾丸生殖细胞肿瘤患者的晚期复发很少见，除了那些表现为转移性NSGCT的患者外，5年后可能不需要进行随访以检测复发。
