Shayegan Bobby, Carver Brett S, Stasi Jason, Motzer Robert J, Bosl George J, Sheinfeld Joel
Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
BJU Int. 2007 May;99(5):993-7. doi: 10.1111/j.1464-410X.2007.06740.x.
To evaluate the outcome in patients treated with chemotherapy and retroperitoneal lymph node dissection (RPLND) after an initial diagnosis of International Germ Cell Cancer Collaborative Group (IGCCCG) intermediate- and poor-risk metastatic nonseminomatous testicular germ cell tumour (NSGCT), as the integration of chemotherapy and surgery in managing advanced NSGCT continues to develop.
Between 1989 and 2003, 157 patients initially diagnosed with IGCCCG intermediate- and poor-risk NSGCT had RPLND after chemotherapy at the authors' institution, with a median follow-up of 36 months. Progression-free probability (PFP) and disease-specific survival (DSS) were estimated using the Kaplan-Meier method. Cox proportional hazards regression analysis was used to assess the prognostic significance of risk factors for disease progression after RPLND.
In all, 68 (43%) and 89 (57%) patients were assigned as intermediate- and poor-risk, respectively. At the time of RPLND the median residual retroperitoneal mass was 3.0 cm and 29 (19%) men had elevated serum tumour markers (alpha-fetoprotein, human chorionic gonadotrophin, or both). Retroperitoneal residual masses were completely resected in 147 (94%) patients; retroperitoneal histology revealed fibrosis in 73 (47%), teratoma in 63 (40%) and viable GCT in 21 (13%). The 5-year overall DSS and PFP were 81% and 70%, respectively. Patients with poor-risk NSGCT were at no greater risk of disease progression than those with intermediate-risk NSGCT. In a multivariate analysis, residual mass size, incomplete surgical resection and the presence of teratoma and viable germ cell cancer independently predicted disease progression after RPLND.
Patients with advanced NSGCT have long-term freedom from disease progression when chemotherapy is combined with resection of residual masses. Our data suggest that the tumour response to chemotherapy, coupled with complete resection of all residual masses, predicts long-term freedom from disease progression.
随着化疗与手术相结合在晚期非精原细胞瘤性睾丸生殖细胞肿瘤（NSGCT）治疗中的不断发展，评估国际生殖细胞癌协作组（IGCCCG）中危和低危转移性非精原细胞瘤性睾丸生殖细胞肿瘤患者在接受化疗和腹膜后淋巴结清扫术（RPLND）后的治疗结果。
1989年至2003年间，157例最初诊断为IGCCCG中危和低危NSGCT的患者在作者所在机构接受化疗后进行了RPLND，中位随访时间为36个月。采用Kaplan-Meier法估计无进展概率（PFP）和疾病特异性生存率（DSS）。采用Cox比例风险回归分析评估RPLND后疾病进展危险因素的预后意义。
总共68例（43%）和89例（57%）患者分别被归类为中危和低危。在进行RPLND时，腹膜后残留肿块的中位大小为3.0 cm，29例（19%）男性血清肿瘤标志物（甲胎蛋白、人绒毛膜促性腺激素或两者）升高。147例（94%）患者的腹膜后残留肿块被完全切除；腹膜后组织学检查显示73例（47%）为纤维化，63例（40%）为畸胎瘤，21例（13%）为存活的生殖细胞肿瘤。5年总体DSS和PFP分别为81%和70%。低危NSGCT患者的疾病进展风险并不高于中危NSGCT患者。在多变量分析中，残留肿块大小、手术切除不完全以及畸胎瘤和存活生殖细胞癌的存在独立预测RPLND后疾病进展。
当化疗与残留肿块切除相结合时，晚期NSGCT患者可长期无疾病进展。我们的数据表明，肿瘤对化疗的反应以及所有残留肿块的完全切除可预测长期无疾病进展。
