Lund University Hospital, Lund University, Lund, Sweden.
J Clin Oncol. 2011 May 20;29(15):2032-9. doi: 10.1200/JCO.2010.29.1278. Epub 2011 Apr 11.
From 1995 to 2003, 603 adult patients from Sweden and Norway with metastatic testicular nonseminomatous germ cell tumor (NSGCT) were included prospectively in a population-based protocol with strict guidelines for staging, treatment, and follow-up. Patients with extragonadal primary tumor or previous treatment for contralateral testicular tumor were excluded. The basic strategy was to individualize treatment according to initial tumor marker response.
Initial treatment for all patients was two courses of standard bleomycin, etoposide, and cisplatin (BEP), with tumor markers analyzed weekly. Good response was defined as a half-life (t(1/2)) for α-fetoprotein (AFP) of ≤ 7 days and/or for β-human chorionic gonadotropin (β-HCG) of ≤ 3 days. Patients with prolonged marker t(1/2) (ie, poor response) received intensification with addition of ifosfamide (BEP-if/PEI) in step 1. If poor response continued, the treatment was intensified with high-dose chemotherapy with stem-cell rescue as step 2.
Overall, 99% of all patients with metastatic testicular NSGCT in the population were included in the protocol. Median follow-up was 8.2 years. Seventy-seven percent of the patients were treated with BEP alone; 18% received intensification step 1%, and 5% received intensification step 2. Grouped according to International Germ Cell Consensus Classification, 10-year overall survival was 94.7% in good-prognosis patients, 90.0% in intermediate-prognosis patients, and 67.4% in poor-prognosis patients.
With detailed treatment protocols and a dedicated collaborative group of specialists, treatment results comparable to those reported from large single institutions can be achieved at national level. With the treatment principles used in Swedish-Norwegian Testicular Cancer Group study SWENOTECA IV, the survival of intermediate-prognosis patients is remarkable and close to that of good-prognosis patients.
1995 年至 2003 年，603 例来自瑞典和挪威的转移性睾丸非精原细胞瘤生殖细胞肿瘤（NSGCT）成年患者被纳入一项基于人群的前瞻性方案，该方案对分期、治疗和随访有严格的指导原则。患有性腺外原发性肿瘤或对侧睾丸肿瘤既往治疗的患者被排除在外。基本策略是根据初始肿瘤标志物反应个体化治疗。
所有患者的初始治疗均为两周期标准博来霉素、依托泊苷和顺铂（BEP），每周分析肿瘤标志物。良好反应定义为甲胎蛋白（AFP）半衰期（t（1/2））≤7 天和/或β-人绒毛膜促性腺激素（β-HCG）t（1/2）≤3 天。标志物 t（1/2）延长（即反应差）的患者在第 1 步中加用异环磷酰胺（BEP-if/PEI）强化。如果反应持续不佳，第 2 步采用大剂量化疗加干细胞解救强化治疗。
总体而言，人群中 99%的转移性睾丸 NSGCT 患者均纳入方案。中位随访 8.2 年。77%的患者接受 BEP 单药治疗；18%的患者接受 1 步强化治疗，5%的患者接受 2 步强化治疗。按国际生殖细胞共识分类分组，10 年总生存率在预后良好的患者中为 94.7%，在预后中等的患者中为 90.0%，在预后不良的患者中为 67.4%。
通过详细的治疗方案和专门的专家协作组，可以在国家层面上实现与大型单一机构报告的可比治疗结果。使用瑞典-挪威睾丸癌研究组 SWENOTECA IV 采用的治疗原则，中预后患者的生存率显著提高，接近良好预后患者。
