Alomary Ibraheem, Samant Rajiv, Gallant Victor
Radiation Oncology Department, Ottawa Hospital Regional Cancer Center, Ottawa, Canada.
Urol Oncol. 2006 May-Jun;24(3):180-3. doi: 10.1016/j.urolonc.2005.05.010.
To review the treatment and outcomes in patients with stage I seminoma after orchidectomy.
A retrospective chart review of all patients with stage I seminoma referred for initial treatment during the last 15 years was performed. Initial treatment approaches and outcomes were analyzed. Comparisons were made between patients treated with adjuvant radiotherapy and those receiving no adjuvant therapy (surveillance group).
A total of 150 patients with stage I seminoma was seen between 1989 and 2003. Median age at diagnosis was 37.5 years (range 19-79), with a median follow-up of 54 months (range 1-162). Of the patients, 71% were treated with adjuvant radiotherapy, and 29% were placed on a surveillance protocol. The 5-year relapse-free survival and overall survival for the entire group were 95% and 100%, respectively. The 5-year relapse-free survival for the adjuvant radiotherapy group was 100% compared with 79% for the surveillance group (P < 0.001). Of the 6 patients who had a relapse, 5 were salvaged with radiation, but 1 required chemotherapy as well. One patient who had a relapse is currently refusing treatment for recurrence.
Our results confirm the excellent prognosis for patients with stage I seminoma and indicate that surveillance does not compromise survival. This result adds to the evidence that surveillance is a good option for many patients and also supports our current approach, which favors surveillance for most patients with stage I seminoma after orchidectomy who are willing to go on our surveillance protocol.
回顾睾丸切除术后Ⅰ期精原细胞瘤患者的治疗及预后情况。
对过去15年中所有因初始治疗而转诊的Ⅰ期精原细胞瘤患者进行回顾性病历审查。分析初始治疗方法及预后情况。对接受辅助放疗的患者与未接受辅助治疗的患者（监测组）进行比较。
1989年至2003年间共诊治150例Ⅰ期精原细胞瘤患者。诊断时的中位年龄为37.5岁（范围19 - 79岁），中位随访时间为54个月（范围1 - 162个月）。其中，71%的患者接受了辅助放疗，29%的患者进入监测方案。整个组的5年无复发生存率和总生存率分别为95%和100%。辅助放疗组的5年无复发生存率为100%，而监测组为79%（P < 0.001）。在6例复发的患者中，5例通过放疗挽救，但1例还需要化疗。1例复发患者目前拒绝接受复发治疗。
我们的结果证实了Ⅰ期精原细胞瘤患者预后良好，并表明监测不会影响生存率。这一结果进一步证明监测对许多患者来说是一个不错的选择，也支持了我们目前的方法，即对于大多数睾丸切除术后愿意接受我们监测方案的Ⅰ期精原细胞瘤患者，倾向于采用监测。
