Valdevenito Sepúlveda Juan Pablo, Merhe Nieva Emilio, Valdevenito Sepúlveda Raúl, Cuevas Toro Miguel, Gómez Gallo Alvaro, Bermúdez Luna Hugo, Contreras Meléndez Luis, Gallegos Méndez Iván, Gallardo Escobar Jorge, Palma Ceppi Cristián
Servicios de Urología, Anatomía Patológica y Oncología, Hospital Clinico Universidad de Chile, Santiago, Chile.
Arch Esp Urol. 2007 Apr;60(3):245-54. doi: 10.4321/s0004-06142007000300004.
The best treatment of clinical stage I non-seminomatous germ cell testicular cancer (NSGCTC) is controversial. Lymphadenectomy allows an adequate retroperitoneal staging and cures up to 70% of patients in pathological stage II. The objective of this study is to analyse our experience in the treatment of this patients with radical orchiectomy and reduced retroperitoneal lymphadenectomy (RRL) as the initial treatment.
Retrospective study of patients with clinical stage I NSGCTC submitted to radical orchiectomy and RRL at the Urology Service of the University of Chile Clinical Hospital, from January 1990 to December 2000.
retroperitoneal staging with computed tomography (CT), normal tumor markers after orchiectomy and testicular and retroperitoneal biopsy informed at our hospital. The following metastatic risk factors in the testicular biopsy were checked: vascular invasion (venous and/or lymphatic), infiltration of tunica albuginea, rete testis, epididymis, and spermatic cord.
36 patients with 37 testicular tumors were analysed (1 bilateral case). Average age 28 years old. Twenty nine mixed tumors (78%); most frequent histology embryonal carcinoma (76%). Average surgery time 2 hr 7 min; average dissected lymph nodes 13. Introoperative complications: 2,8%; postoperative complications: a) early 5,6%; b) late: 5,6%. No mortality, no second surgeries nor blood transfusions. Four cases of positive RRL (11%). Only retroperitoneal relapses in 2 cases (8%), one out of the limits of dissection. Chemotherapy in 7 patients (19%) a total of 18 cycles. Four cases of contralateral tumor during follow-up (11%). Hundred percent survival at 76 months (16-160). We described sensibility, specificity, positive and negative predictive value of metastatic risk factors. Only epididymis infiltration was a significant predictor of metastasis (p=0,04).
In our hands RRL is a safe surgery, with 5,6% mayor complications. The low false negative rate of CT in staging (11%) and the high number of retroperitoneal relapses (8%) in our study contrast with those of other publications. Limited by the size of our study group, the epididymis infiltration was the only statistically significant predictor of metastasis. Clinical stage I NSGCTC initially managed with RRL has a 100% survival.
临床I期非精原细胞性生殖细胞睾丸癌（NSGCTC）的最佳治疗方法存在争议。淋巴结清扫术可实现充分的腹膜后分期，能治愈高达70%病理II期的患者。本研究的目的是分析我们以根治性睾丸切除术和简化腹膜后淋巴结清扫术（RRL）作为初始治疗方法治疗此类患者的经验。
对1990年1月至2000年12月在智利大学临床医院泌尿外科接受根治性睾丸切除术和RRL的临床I期NSGCTC患者进行回顾性研究。
通过计算机断层扫描（CT）进行腹膜后分期，睾丸切除术后肿瘤标志物正常，且在我院进行睾丸及腹膜后活检。检查睾丸活检中的以下转移风险因素：血管侵犯（静脉和/或淋巴管）、白膜、睾丸网、附睾和精索的浸润。
分析了36例患者的37个睾丸肿瘤（1例双侧病例）。平均年龄28岁。29例混合性肿瘤（78%）；最常见的组织学类型为胚胎癌（76%）。平均手术时间2小时7分钟；平均清扫淋巴结13个。术中并发症：2.8%；术后并发症：a）早期5.6%；b）晚期：5.6%。无死亡病例，无二次手术及输血情况。4例RRL阳性（11%）。仅2例腹膜后复发（8%），其中1例超出清扫范围。7例患者（19%）接受化疗，共18个周期。随访期间4例对侧肿瘤（11%）。76个月时生存率为100%（16 - 160个月）。我们描述了转移风险因素的敏感性、特异性、阳性和阴性预测值。仅附睾浸润是转移的显著预测因素（p = 0.04）。
在我们的经验中，RRL是一种安全的手术，主要并发症发生率为5.6%。我们研究中CT分期的低假阴性率（11%）和腹膜后高复发率（8%）与其他文献报道的情况形成对比。受我们研究组规模限制，附睾浸润是唯一具有统计学意义的转移预测因素。最初采用RRL治疗的临床I期NSGCTC患者生存率为100%。
