Skakkebaek N E, Rajpert-De Meyts E, Jørgensen N, Main K M, Leffers H, Andersson A-M, Juul A, Jensen T K, Toppari J
University Department of Growth and Reproduction GR, Rigshospitalet, Copenhagen, Denmark.
Int J Androl. 2007 Aug;30(4):198-204; discussion 204-5. doi: 10.1111/j.1365-2605.2007.00776.x.
Recently a worldwide rise in the incidence of testicular germ cell cancer (TGCC) has been repeatedly reported. The changing disease pattern may signal that other testicular problems may also be increasing. We have reviewed recent research progress, in particular evidence gathered in the Nordic countries, which shows strong associations between testicular cancer, undescended testis, hypospadias, poor testicular development and function, and male infertility. These studies have led us to suggest the existence of a testicular dysgenesis syndrome (TDS), of which TGCC, undescended testis, hypospadias/disorders of sex differentiation and male fertility problems may be symptoms with varying penetration. In spite of their fetal origin, most of the TDS symptoms, including TGCC and poor semen quality, can only be diagnosed in adulthood. Data from a Danish-Finnish research collaboration strongly suggest that trends in TGCC rates of a population may be 'whistle blowers' of other reproductive health problems. As cancer registries are often of excellent quality - in contrast to registries for congenital abnormalities - health authorities should consider an increase in TGCC as a warning that other reproductive health problems may also be rising.
最近，全球范围内睾丸生殖细胞癌（TGCC）的发病率呈上升趋势，这一现象已被多次报道。疾病模式的变化可能预示着其他睾丸问题也在增加。我们回顾了近期的研究进展，特别是北欧国家收集的证据，这些证据表明睾丸癌、隐睾、尿道下裂、睾丸发育及功能不良与男性不育之间存在密切关联。这些研究使我们提出存在一种睾丸发育不全综合征（TDS），其中TGCC、隐睾、尿道下裂/性分化障碍以及男性生育问题可能是具有不同外显率的症状。尽管TDS的症状起源于胎儿期，但包括TGCC和精液质量差在内的大多数症状只能在成年期被诊断出来。丹麦 - 芬兰研究合作的数据有力地表明，一个人群中TGCC发病率的趋势可能是其他生殖健康问题的“警示信号”。由于癌症登记通常质量很高——与先天性异常登记不同——卫生当局应将TGCC发病率的增加视为一个警示，即其他生殖健康问题可能也在上升。
