Beck Stephen D W, Foster Richard S, Bihrle Richard, Cheng Liang, Donohue John P
Department od Urology, Indiana University Medical Center, Indiana Cancer Pavilion, Indianapolis, Indiana 46202, USA.
J Urol. 2005 Oct;174(4 Pt 1):1287-90; discussion 1290. doi: 10.1097/01.ju.0000173925.80551.9e.
We evaluated the prognostic significance of the histology of metastatic lymph nodes to predict postoperative relapse in pathological stage B1 nonseminomatous germ cell tumor (NSGCT).
A retrospective review of the testicular cancer database was performed to identify all patients with clinical stage A NSGCT who underwent primary retroperitoneal lymph node dissection and were found to have pathological stage B1 disease. No patient received adjuvant chemotherapy and minimal followup was 24 months.
A total of 118 patients were identified with a 5-year disease-free survival (DFS) of 68% and a median followup of 43 months. Embryonal cell carcinoma was identified in 92 of 118 (77%) surgical specimens, which was significantly greater than the presence of teratoma (22%), seminoma (16%) and yolk sac (14.4%, p < or = 0.001) with no difference in 5-year DFS comparing the presence or absence of each histology. Solitary histology was noted in 88 of 118 patients (74.5%). Embryonal cell carcinoma was the most common single histology identified at surgery at 64 of 88 (73%), with the incidence of seminoma, teratoma and yolk sac being 12.5%, 9.0% and 5.5%, respectively (p < or = 0.001). There was no statistical difference in DFS for each of the solitary histological subtypes (p=0.67). Recurrence rates were similar for pure embryonal cell carcinoma (69%), mixed embryonal cell carcinoma (63%) and no embryonal cell carcinoma (73%) in the retroperitoneum (p=0.63).
Retroperitoneal histology does not appear to predict outcome in patients with pathological stage B1 NSGCT.
我们评估转移性淋巴结组织学对预测病理分期为B1期的非精原细胞瘤性生殖细胞肿瘤（NSGCT）术后复发的预后意义。
对睾丸癌数据库进行回顾性分析，以确定所有临床分期为A期的NSGCT患者，这些患者接受了原发性腹膜后淋巴结清扫术，且术后病理分期为B1期。所有患者均未接受辅助化疗，最短随访时间为24个月。
共纳入118例患者，5年无病生存率（DFS）为68%，中位随访时间为43个月。118例手术标本中有92例（77%）发现胚胎性癌，显著高于畸胎瘤（22%）、精原细胞瘤（16%）和卵黄囊瘤（14.4%，p≤0.001）的比例，且每种组织学类型的存在与否对5年DFS无差异。118例患者中有88例（74.5%）为单一组织学类型。胚胎性癌是手术中最常见的单一组织学类型，88例中有64例（73%），精原细胞瘤、畸胎瘤和卵黄囊瘤的发生率分别为12.5%、9.0%和5.5%（p≤0.001）。各单一组织学亚型的DFS无统计学差异（p = 0.67）。腹膜后单纯胚胎性癌（69%）、混合性胚胎性癌（63%）和无胚胎性癌（73%）的复发率相似（p = 0.63）。
腹膜后组织学似乎不能预测病理分期为B1期的NSGCT患者的预后。
