Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
J Urol. 2011 Dec;186(6):2245-8. doi: 10.1016/j.juro.2011.07.101. Epub 2011 Oct 19.
Percent of embryonal carcinoma and lymphovascular invasion in the primary tumor are risk factors for occult retroperitoneal metastatic disease. High risk patients with clinical stage I and IIA nonseminomatous germ cell tumor who underwent primary retroperitoneal lymph node dissection were identified to discern any other risk factors for metastatic disease.
Patients who had undergone retroperitoneal lymph node dissection at our institution from 1993 to 2009 were identified and clinical charts were reviewed. A total of 90 patients with orchiectomy specimens containing more than 30% embryonal carcinoma who underwent primary retroperitoneal lymph node dissection were identified and perioperative data were obtained.
Of 353 patients 90 (25%) had greater than 30% embryonal carcinoma and underwent primary retroperitoneal lymph node dissection. Of these patients 45 (50%) had lymphovascular invasion. Median followup was 1.1 years. Positive lymph nodes identified at retroperitoneal lymph node dissection were noted in 30 (46%) and 15 (60%) patients with clinical stage I vs clinical stage II disease. On multivariate analysis embryonal carcinoma (OR 1.02, 95% CI 1.00-1.04) and lymphovascular invasion (OR 3.52, 95% CI 1.43-8.67) were associated with positive lymph nodes at retroperitoneal lymph node dissection. The positive predictive value for 100% embryonal carcinoma was 65.5%, although the negative predictive value for 30% embryonal carcinoma was 85.7%.
Embryonal carcinoma and lymphovascular invasion were significantly and independently associated with the risk of occult retroperitoneal metastatic disease. These results should be considered when counseling patients about appropriate treatment options.
胚胎癌和血管淋巴管侵犯在原发性肿瘤中的百分比是隐匿性腹膜后转移性疾病的危险因素。通过识别接受原发性腹膜后淋巴结清扫术的临床 I 期和 IIA 期非精原细胞瘤生殖细胞肿瘤的高危患者，以发现转移性疾病的任何其他危险因素。
确定了 1993 年至 2009 年在我院接受腹膜后淋巴结清扫术的患者，并对临床病历进行了回顾。共确定了 90 例接受原发性腹膜后淋巴结清扫术的睾丸切除术标本中胚胎癌比例大于 30%的患者，并获得了围手术期数据。
在 353 例患者中，有 90 例（25%）胚胎癌比例大于 30%，并接受了原发性腹膜后淋巴结清扫术。其中 45 例（50%）有血管淋巴管侵犯。中位随访时间为 1.1 年。在腹膜后淋巴结清扫术时发现阳性淋巴结的患者中，临床 I 期和 II 期疾病患者分别为 30 例（46%）和 15 例（60%）。多因素分析显示，胚胎癌（OR 1.02，95%CI 1.00-1.04）和血管淋巴管侵犯（OR 3.52，95%CI 1.43-8.67）与腹膜后淋巴结清扫术时阳性淋巴结相关。100%胚胎癌的阳性预测值为 65.5%，而 30%胚胎癌的阴性预测值为 85.7%。
胚胎癌和血管淋巴管侵犯与隐匿性腹膜后转移性疾病的风险显著相关。在为患者提供适当的治疗选择时应考虑这些结果。
