Schmoll H J, Souchon R, Krege S, Albers P, Beyer J, Kollmannsberger C, Fossa S D, Skakkebaek N E, de Wit R, Fizazi K, Droz J P, Pizzocaro G, Daugaard G, de Mulder P H M, Horwich A, Oliver T, Huddart R, Rosti G, Paz Ares L, Pont O, Hartmann J T, Aass N, Algaba F, Bamberg M, Bodrogi I, Bokemeyer C, Classen J, Clemm S, Culine S, de Wit M, Derigs H G, Dieckmann K P, Flasshove M, Garcia del Muro X, Gerl A, Germa-Lluch J R, Hartmann M, Heidenreich A, Hoeltl W, Joffe J, Jones W, Kaiser G, Klepp O, Kliesch S, Kisbenedek L, Koehrmann K U, Kuczyk M, Laguna M P, Leiva O, Loy V, Mason M D, Mead G M, Mueller R P, Nicolai N, Oosterhof G O N, Pottek T, Rick O, Schmidberger H, Sedlmayer F, Siegert W, Studer U, Tjulandin S, von der Maase H, Walz P, Weinknecht S, Weissbach L, Winter E, Wittekind C
European Germ Cell Cancer Consensus Group, Martin-Luther-University, Department of Hematology/Oncology, Halle, Germany.
Ann Oncol. 2004 Sep;15(9):1377-99. doi: 10.1093/annonc/mdh301.
Germ cell tumour is the most frequent malignant tumour type in young men with a 100% rise in the incidence every 20 years. Despite this, the high sensitivity of germ cell tumours to platinum-based chemotherapy, together with radiation and surgical measures, leads to the high cure rate of > or = 99% in early stages and 90%, 75-80% and 50% in advanced disease with 'good', 'intermediate' and 'poor' prognostic criteria (IGCCCG classification), respectively. The high cure rate in patients with limited metastatic disease allows the reduction of overall treatment load, and therefore less acute and long-term toxicity, e.g. organ sparing surgery for specific cases, reduced dose and treatment volume of irradiation or substitution of node dissection by surveillance or adjuvant chemotherapy according to the presence or absence of vascular invasion. Thus, different treatment options according to prognostic factors including histology, stage and patient factors and possibilities of the treating centre as well may be used to define the treatment strategy which is definitively chosen for an individual patient. However, this strategy of reduction of treatment load as well as the treatment itself require very high expertise of the treating physician with careful management and follow-up and thorough cooperation by the patient as well to maintain the high rate for cure. Treatment decisions must be based on the available evidence which has been the basis for this consensus guideline delivering a clear proposal for diagnostic and treatment measures in each stage of gonadal and extragonadal germ cell tumour and individual clinical situations. Since this guideline is based on the highest evidence level available today, a deviation from these proposals should be a rare and justified exception.
生殖细胞肿瘤是年轻男性中最常见的恶性肿瘤类型，发病率每20年上升100%。尽管如此，生殖细胞肿瘤对铂类化疗、放疗和手术措施具有高度敏感性，这使得早期治愈率高达99%及以上，而在晚期疾病中，根据“良好”“中等”和“不良”预后标准（国际生殖细胞癌协作组分类），治愈率分别为90%、75 - 80%和50%。转移性疾病局限的患者治愈率高，这使得整体治疗负担得以减轻，从而减少急性和长期毒性，例如针对特定病例进行保留器官手术、减少放疗剂量和治疗体积，或根据有无血管侵犯，用监测或辅助化疗替代淋巴结清扫术。因此，可根据包括组织学、分期和患者因素以及治疗中心的条件等预后因素，采用不同的治疗方案来确定为个体患者最终选择的治疗策略。然而，这种减轻治疗负担的策略以及治疗本身都需要治疗医生具备非常高的专业知识，同时需要精心管理和随访，患者也要密切配合，以维持高治愈率。治疗决策必须基于现有证据，而这些证据是本共识指南的基础，该指南针对性腺和性腺外生殖细胞肿瘤的各个阶段以及个体临床情况，就诊断和治疗措施提出了明确建议。由于本指南基于当今可得的最高证据水平，偏离这些建议应是罕见且合理的例外情况。
