Department of Surgery, Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
Ann Surg Oncol. 2010 Jun;17(6):1682-7. doi: 10.1245/s10434-010-1036-x. Epub 2010 Mar 24.
Despite high response rates to systemic chemotherapy, 30% of patients with advanced stage testicular carcinoma will have extra-retroperitoneal residual masses that require resection. Most often, these are located in the lungs and mediastinum and neck. Limited data are available concerning the incidence, surgical management, and follow-up of neck metastasis arising from a testicular primary tumor.
We retrospectively reviewed all 665 patients who were referred to a tertiary referral center with the diagnosis of testicular cancer from January 1997 to June 2009 for the presence of cervical metastases. Patients who underwent concomitant surgical therapy were identified and analyzed. Clinical and pathological data were collected from patient records, including radiology and pathology reports. Furthermore, data on primary treatment strategy, chemotherapeutic regimens, timing of surgical procedures, complications, disease recurrence, and follow-up were collected.
Twenty-six patients (4%) had cervical lymph node metastasis. The majority (n = 19) had multiple ERP sites. Nine patients (35%) underwent selective neck dissection: in six patients, this was indicated because of residual masses after chemotherapy, and in three patients, cervical masses represented a late and distant relapse of previously treated disease. Viable cancer cells were present in the resected specimen only in these three patients. Seven patients are currently without evidence of disease. Two patients died of disseminated disease.
Cervical lymph node metastases originating from testicular cancer are rare but are more commonly observed in patients with advanced stage disease. Selective neck dissection can be safely performed both after chemotherapy and in the case of recurrent disease.
尽管全身化疗的反应率很高，但 30%的晚期睾丸癌患者仍会有需要切除的腹膜后残留肿块。这些肿块大多位于肺部、纵隔和颈部。关于源自睾丸原发性肿瘤的颈部转移的发生率、手术治疗和随访，只有有限的数据。
我们回顾性分析了 1997 年 1 月至 2009 年 6 月期间，在一家三级转诊中心就诊的 665 例诊断为睾丸癌的患者中是否存在颈部转移。确定并分析了同时接受手术治疗的患者。从患者记录中收集了临床和病理数据，包括影像学和病理学报告。此外，还收集了原发性治疗策略、化疗方案、手术时机、并发症、疾病复发和随访的数据。
26 例（4%）患者有颈部淋巴结转移。大多数患者（n=19）有多个 ERP 部位。9 例患者（35%）行选择性颈部淋巴结清扫术：其中 6 例因化疗后残留肿块而进行，3 例因颈部肿块为先前治疗疾病的晚期和远处复发。仅在这 3 例患者的切除标本中发现有存活的癌细胞。目前 7 例患者无疾病证据。2 例患者死于播散性疾病。
源自睾丸癌的颈部淋巴结转移罕见，但在晚期疾病患者中更为常见。选择性颈部淋巴结清扫术可在化疗后和复发病例中安全进行。
