Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 20015, USA.
Urol Oncol. 2012 Jan-Feb;30(1):60-3. doi: 10.1016/j.urolonc.2009.12.006. Epub 2010 Mar 2.
The presence of teratoma in the primary orchiectomy specimen creates controversies for subsequent management. Although predominant teratoma is less likely to metastasize, teratoma in the retroperitoneum may be less amenable to chemotherapy. In order to elucidate the issues about teratoma in the primary tumor, we reviewed differences between primary retroperitoneal lymph node dissection (P-RPLND) vs. post-chemotherapy RPLND (PC-RPLND) in patients with teratoma at orchiectomy.
Patients who had undergone RPLND at our institution from 2001 to 2008 were identified, and clinical charts reviewed. Eighty-three patients with teratoma at orchiectomy were identified and perioperative data were obtained.
Of the 83 patients with teratoma at orchiectomy who underwent RPLND, 44 (53%) and 39 (47%) underwent primary and PC-RPLND, respectively. Median follow-up was 1.4 years. Of the 83 patients with primary teratoma at orchiectomy, there were 7 (8%) patients with pure teratoma and 76 (92%) patients with mixed histology. Of the patients with mixed histology, 72 (87%) patients had embryonal carcinoma and 36 (43%) had LVI. There were 19 (43%) positive lymph nodes for P-RPLND, of which 13 (30%) contained teratoma. For the PC-RPLND group, 30 (77%) of lymph nodes were positive, of which 28 (72%) contained teratoma. There were 3 (4%) recurrences overall, all of which recurred in the PC-RPLND group. There were 11 (13%) perioperative complications total. There were no deaths in either group.
Patients with teratoma at orchiectomy were associated with other high risk features and are at significant risk for metastatic disease. Patients with post-chemotherapy retroperitoneal findings are at significant risk for viable GCT and/or teratoma and should undergo PC-RPLND.
在初次睾丸切除术标本中发现畸胎瘤会引发后续管理的争议。虽然主要的畸胎瘤不太可能转移，但腹膜后畸胎瘤可能对化疗的反应较差。为了阐明原发肿瘤中畸胎瘤的问题，我们回顾了在我院接受治疗的患者中，初次腹膜后淋巴结清扫术（P-RPLND）与化疗后腹膜后淋巴结清扫术（PC-RPLND）在睾丸切除术后畸胎瘤患者中的差异。
确定了 2001 年至 2008 年在我院接受 RPLND 治疗的患者，并对临床病历进行了回顾。共确定了 83 例睾丸切除术后畸胎瘤患者，并获得了围手术期数据。
在 83 例睾丸切除术后接受 RPLND 的畸胎瘤患者中，44 例（53%）和 39 例（47%）分别接受了初次和 PC-RPLND。中位随访时间为 1.4 年。在 83 例原发性睾丸畸胎瘤患者中，有 7 例（8%）为单纯畸胎瘤，76 例（92%）为混合组织学。在混合组织学患者中，有 72 例（87%）患者有胚胎癌，36 例（43%）患者有 LVI。初次腹膜后淋巴结清扫术有 19 例（43%）淋巴结阳性，其中 13 例（30%）含有畸胎瘤。对于 PC-RPLND 组，30 例（77%）淋巴结阳性，其中 28 例（72%）含有畸胎瘤。总体有 3 例（4%）复发，均发生在 PC-RPLND 组。共有 11 例（13%）围手术期并发症。两组均无死亡病例。
睾丸切除术后的畸胎瘤患者伴有其他高危特征，存在发生转移性疾病的显著风险。化疗后腹膜后发现的患者存在有活力的 GCT 和/或畸胎瘤的显著风险，应接受 PC-RPLND。
