Germà-Lluch J R, Garcia del Muro X, Maroto P, Paz-Ares L, Arranz J A, Gumà J, Alba E, Sastre J, Aparicio J, Fernández A, Barnadas A, Terrassa J, Sáenz A, Almenar D, López-Brea M, Climent M A, Sánchez M A, Lasso de la Vega R, Berenguer G, Pérez X
Department of Medical Oncology, Institut Català d'Oncologia, Hospital Duran y Reynals, Av. Gran via s/n, Km 2,7, 08907 Hospitalet, Barcelona, Spain.
Eur Urol. 2002 Dec;42(6):553-62; discussion 562-3. doi: 10.1016/s0302-2838(02)00439-6.
To describe the clinical characteristics and treatment results obtained with the application of a homogeneous treatment protocol in 1490 patients with germ-cell tumours (GCT) registered in the 55 hospitals belonging to the Spanish Germ-Cell Cancer Group (GG) during the period between January 1994 and April 2001.
In general, surveillance was the common policy for stage I patients without local poor prognosis factors, whereas they received adjuvant chemotherapy in case those factor were present. Chemotherapy schedules used in advanced cases were cisplatin and etoposide (EP) for seminoma and BEP or BOMP-EPI in non-seminoma, according to whether the patient was in the good or poor prognosis IGCCCG (International Germ-Cell Cancer Collaborative Group) group. Excision of residual masses was mandatory in non-seminomatous germ-cell tumour (NSGCT).
Initial local symptomatology was increased testis size in 90% of cases. Sonography was an excellent diagnostic tool to suggest tumour. Non-seminoma (64.2%) was more frequent than seminoma (35.8%). Approximately 10% had the antecedent of cryptorchidism. Non-seminoma patients were 7 years younger than seminoma. Right testis was involved predominantly. Pre-orchidectomy tumour markers were elevated in 21% of seminoma (betaHGC) and 79% in non-seminoma (alphaFP and/or betaHGC). Scrotum violation occurred in only 1.8%. There were significant differences among stage I and the IGCCCG prognosis groups related to a longer interval between the first symptom and orchiectomy. Eighteen percent of non-seminomatous germ-cell tumour belonged to the poor prognosis IGCCCG group. With a median follow-up to 33 months, this series has achieved a 3 year overall survival of 98% for seminoma and 94% for non-seminoma. Only 10% of excised residual masses present after chemotherapy contained malignant cells.
Spanish GCT have a similar clinical pattern to that described in the other occidental countries except for a slight increased proportion of non-seminoma upon seminoma. Co-operative groups as GG are unique structures to obtain quick and wide experience on the treatment of testis tumours, contributing to achieve a high cure rate.
描述1994年1月至2001年4月期间，西班牙生殖细胞癌研究组（GG）下属55家医院登记的1490例生殖细胞肿瘤（GCT）患者应用统一治疗方案后的临床特征及治疗结果。
一般而言，对于无局部预后不良因素的I期患者，通常采取观察策略；若存在这些因素，则接受辅助化疗。晚期病例中，根据患者属于国际生殖细胞癌协作组（IGCCCG）预后良好或不良组，精原细胞瘤采用顺铂和依托泊苷（EP）化疗方案，非精原细胞瘤采用BEP或BOMP-EPI方案。非精原细胞性生殖细胞肿瘤（NSGCT）患者必须切除残留肿块。
90%的病例最初的局部症状为睾丸增大。超声检查是提示肿瘤的优秀诊断工具。非精原细胞瘤（64.2%）比精原细胞瘤（35.8%）更常见。约10%有隐睾病史。非精原细胞瘤患者比精原细胞瘤患者年轻7岁。右侧睾丸受累为主。睾丸切除术前，21%的精原细胞瘤患者肿瘤标志物（β-HCG）升高，79%的非精原细胞瘤患者（甲胎蛋白和/或β-HCG）升高。阴囊侵犯仅占1.8%。I期与IGCCCG预后组之间存在显著差异，表现为首发症状至睾丸切除的间隔时间更长。18%的非精原细胞性生殖细胞肿瘤属于IGCCCG预后不良组。中位随访33个月，该系列精原细胞瘤患者3年总生存率为98%，非精原细胞瘤患者为94%。化疗后切除的残留肿块中仅10%含有恶性细胞。
西班牙GCT的临床模式与其他西方国家描述的相似，只是非精原细胞瘤的比例比精原细胞瘤略有增加。像GG这样的合作组是获取睾丸肿瘤治疗快速广泛经验的独特机构，有助于实现高治愈率。
