Scholz Michael, Höltl Wolfgang
Department of Urology, Kaiser Franz Josef Hospital, Vienna, Austria.
Curr Opin Urol. 2003 Nov;13(6):473-6. doi: 10.1097/01.mou.0000098069.73234.61.
To review current developments in the management of patients with testicular cancer, with special emphasis on risk factors for the primary tumour and treatment options for clinical stage I testicular germ cell tumours.
The management of patients with testicular cancer has substantially improved over the past 25 years. Current concepts for treating localized and regional disease have been influenced by effective systematic chemotherapy. At present, cure rates approach nearly 100% for low-stage disease and more than 80% for advanced disease.
Retroperitoneal lymph node dissection is still favoured as the therapy of choice for clinical stage I non-seminomatous germ cell tumours in many centres, but as risk factors for the primary tumour have become better understood, surveillance and risk-adapted therapy, including surveillance for low-risk patients and adjuvant chemotherapy for the high-risk group, is now being considered a therapeutic option particularly in European centres. Adjuvant radiotherapy is still the gold standard for the treatment of patients with clinical stage I seminoma, but the relapse rate of 19% and a 5-year overall survival of 97.7% make surveillance a possible therapeutic option. The results of phase II and III trials should soon provide additional information on carboplatin for single-agent adjuvant chemotherapy.
回顾睾丸癌患者管理的当前进展，特别强调原发性肿瘤的危险因素以及临床I期睾丸生殖细胞肿瘤的治疗选择。
在过去25年中，睾丸癌患者的管理有了显著改善。治疗局限性和区域性疾病的当前理念受到有效系统化疗的影响。目前，低分期疾病的治愈率接近100%，晚期疾病的治愈率超过80%。
在许多中心，腹膜后淋巴结清扫术仍是临床I期非精原细胞性生殖细胞肿瘤的首选治疗方法，但随着对原发性肿瘤危险因素的更好理解，监测和风险适应性治疗，包括对低风险患者的监测和对高风险组的辅助化疗，现在被认为是一种治疗选择，尤其是在欧洲中心。辅助放疗仍然是临床I期精原细胞瘤患者治疗的金标准，但19%的复发率和97.7%的5年总生存率使监测成为一种可能的治疗选择。II期和III期试验的结果应很快提供关于卡铂单药辅助化疗的更多信息。
