Aass N, Klepp O, Cavallin-Stahl E, Dahl O, Wicklund H, Unsgaard B, Baldetorp L, Ahlström S, Fosså S D
Department of Medical Oncology, Norwegian Radium Hospital, Oslo.
J Clin Oncol. 1991 May;9(5):818-26. doi: 10.1200/JCO.1991.9.5.818.
Between 1981 and 1986, 200 consecutive patients with metastatic nonseminomatous testicular cancer were entered into the Swedish Norwegian Testicular Cancer (SWENOTECA) project from 14 hospitals. The treatment plan was four chemotherapy cycles (cisplatin, vinblastine, and bleomycin) followed by surgical resection of residual tumor masses. After a median observation time of 75 months, the overall 5-year survival rate was 82%. In a univariate analysis, the following parameters influenced the prognosis significantly: the extent of the disease (Medical Research Council [MRC] grouping); the prechemotherapy levels of serum alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH); the patients' age; the presence of extrapulmonary hematogeneous metastases; and/or particularly large lymph node metastases. Patients fared better when more than 3 weeks elapsed between orchiectomy and start of chemotherapy as compared with those who were treated within this interval. The place of treatment (a large oncology unit v smaller units) also represented a significant prognostic factor for patients with large-volume (LV) and very-large-volume (VLV) disease combined. Multivariate analysis (Cox regression proportional hazards model) performed in all 193 assessable patients showed the following adverse prognostic factors: high-volume metastatic burden, age older than 35 years, prechemotherapy AFP greater than 500 micrograms/L and/or HCG greater than 1,000 U/L, and an interval between orchiectomy and start of chemotherapy of less than 3 weeks. The place of treatment also significantly influenced the final outcome. If patients with LV and VLV disease were combined, the presence of two of the following risk factors represented an additional prognostic factor: AFP greater than 1,000 micrograms/L, HCG greater than 10,000 U/L, liver metastases, brain metastases, bone metastases, retroperitoneal tumor greater than or equal to 10 cm, and mediastinal tumor greater than or equal to 5 cm.
1981年至1986年间，来自14家医院的200例转移性非精原细胞瘤性睾丸癌患者连续入选瑞典挪威睾丸癌（SWENOTECA）项目。治疗方案为四个化疗周期（顺铂、长春花碱和博来霉素），随后对残留肿瘤肿块进行手术切除。中位观察时间为75个月后，总体5年生存率为82%。单因素分析显示，以下参数对预后有显著影响：疾病范围（医学研究委员会[MRC]分组）；化疗前血清甲胎蛋白（AFP）、人绒毛膜促性腺激素（HCG）和乳酸脱氢酶（LDH）水平；患者年龄；肺外血行转移的存在；和/或特别大的淋巴结转移。与在此间隔内接受治疗的患者相比，睾丸切除术后与化疗开始之间间隔超过3周的患者预后更好。治疗地点（大型肿瘤治疗单位与小型单位）对于合并有大体积（LV）和超大体积（VLV）疾病的患者也是一个显著的预后因素。对所有193例可评估患者进行的多因素分析（Cox回归比例风险模型）显示了以下不良预后因素：高体积转移负荷、年龄大于35岁、化疗前AFP大于500微克/升和/或HCG大于1000单位/升，以及睾丸切除术后与化疗开始之间的间隔少于3周。治疗地点也显著影响最终结果。如果将LV和VLV疾病的患者合并，存在以下两个危险因素代表另一个预后因素：AFP大于1000微克/升、HCG大于10000单位/升、肝转移、脑转移、骨转移、腹膜后肿瘤大于或等于10厘米，以及纵隔肿瘤大于或等于5厘米。
