Spiess Philippe E, Tannir Nizar M, Brown Gordon A, Liu Ping, Tu Shi-Ming, Evans James G, Pisters Louis L
Department of Urologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Urology. 2007 Dec;70(6):1173-8. doi: 10.1016/j.urology.2007.07.021.
To determine disease-related outcomes in metastatic testis cancer patients with absence of viable cancer in the postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) specimen and determine whether clinical variables can help predict disease progression.
Between 1980 and 2003, 195 patients had no viable tumor at the time of PC-RPLND. We retrospectively reviewed their medical records for pertinent clinical and treatment-related outcomes. At a median follow-up of 45 months (range, 6 to 236 months), 35 patients (18%) developed recurrences, and 18 (9%) died of disease.
On multivariate analysis, predictors of recurrence-free survival in patients with no viable tumor were advanced clinical stage (P = 0.01) and poor-risk International Germ Cell Consensus Classification (IGCCC) group (P = 0.01), whereas predictors of disease-specific survival included an elevated serum beta-human chorionic gonadotropin (hCG) level before PC-RPLND (P = 0.002), pathologic diameter of the retroperitoneal mass (P = 0.05), and postoperative recurrence (P <0.0001). An hCG level greater than 1.2 mIU/mL before PC-RPLND trended toward statistical significance (P = 0.07), and pathologic diameter of the retroperitoneal mass greater than 2.5 cm was statistically significant (P = 0.05) in predicting a poorer disease-specific survival.
Patients with no viable tumor at PC-RPLND remain at risk of recurrence. Several clinical variables, including advanced clinical stage, poor-risk IGCCC group, preoperative serum hCG level, diameter of the retroperitoneal mass on pathology, and postoperative recurrence, help better define which patients are at risk.
确定接受化疗后腹膜后淋巴结清扫术（PC-RPLND）标本中无存活癌细胞的转移性睾丸癌患者的疾病相关转归，并确定临床变量是否有助于预测疾病进展。
1980年至2003年间，195例患者在PC-RPLND时无存活肿瘤。我们回顾性分析了他们的病历，以获取相关的临床和治疗相关转归。中位随访45个月（范围6至236个月），35例患者（18%）出现复发，18例（9%）死于疾病。
多因素分析显示，无存活肿瘤患者无复发生存的预测因素为临床分期晚期（P = 0.01）和高危国际生殖细胞共识分类（IGCCC）组（P = 0.01），而疾病特异性生存的预测因素包括PC-RPLND前血清β-人绒毛膜促性腺激素（hCG）水平升高（P = 0.002）、腹膜后肿块的病理直径（P = 0.05）和术后复发（P <0.0001）。PC-RPLND前hCG水平大于1.2 mIU/mL有统计学意义的趋势（P = 0.07），腹膜后肿块病理直径大于2.5 cm在预测较差的疾病特异性生存方面有统计学意义（P = 0.05）。
PC-RPLND时无存活肿瘤的患者仍有复发风险。包括临床分期晚期、高危IGCCC组、术前血清hCG水平、病理上腹膜后肿块直径和术后复发在内的几个临床变量有助于更好地确定哪些患者有风险。
