睾丸生殖细胞肿瘤转移患者的睾丸切除术时机对生存的影响。

Effect of the timing of orchiectomy on survival in patients with metastatic germ cell tumors of testis.

机构信息

Department of Clinical Pharmacology & Chemotherapy, N. N. Blokhin Russian Cancer Research Center, Moscow, Russia.

出版信息

Urol Oncol. 2014 Jan;32(1):32.e27-33. doi: 10.1016/j.urolonc.2012.12.001. Epub 2013 Apr 28.

DOI:10.1016/j.urolonc.2012.12.001

PMID:23628310

Abstract

OBJECTIVES

Classically, orchiectomy (OE) is the first step of treatment in patients with metastatic germ cell tumors (mGCTs) of testis. However, some patients have severe symptoms of disease, which require immediate beginning of chemotherapy (CT) followed by OE. This retrospective analysis was performed to find the effect of time constraints of delayed OE on survival in patients with mGCT.

METHODS AND MATERIALS

We analyzed the data of 1,483 CT-naive patients with advanced mGCT of the testis treated in our Department from 1986 to 2009. Delayed OE was performed on 71 (4.8%) patients: seminoma in 8 patients (11.2%), nonseminomatous tumor in 50 patients (70.4%), and unknown tumor histology in 13 patients (18.4%). Twenty percent, 40%, and 40% of patients belonged to good, intermediate, and poor International Germ Cell Cancer Consensus Group prognostic groups, respectively. Median time from the beginning of the CT to OE was 18 (range, 1-250) days. OE was performed on 39 (55%), 21 (29.5%), and 11 (15.5%) patients during cycle 1, cycle 2 to completion of CT, and after the finishing of induction CT, respectively. Median follow-up time was 156 (range, 3-241) months. Etoposide and cisplatin-based CTs were received by 66 patients (93%).

RESULTS

Three-year overall survival (OS) of all 1,483 patients was 75%. An excellent primary tumor response to CT was observed among the patients, who had delayed OE after completion of CT (n = 11): only mature teratoma (n = 4) and tumor necrosis (n = 7) were found. The 3-year OS in patients with delayed OE was 63%. OE performed after completion of CT was associated with better prognosis. The 3-year OS in patients with delayed OE performed during the cycle 1 (group 1) was 67%, cycle 2 to completion of CT (group 2) was 39%, and after finishing of CT (group 3) was 88% (groups 1 vs. 3: hazard ratio 3.7, 95% confidence interval 0.69-10.1, P = 0.15; groups 2 vs. 3: P = 0.01, hazard ratio 8.1, 95% confidence interval 1.32-18.,72). It seems that if OE had been performed during CT, the beginning of the successive cycle was delayed and dose intensity of CT was decreased.

CONCLUSIONS

In case of severe symptoms of disease, which require an immediate start of CT, performing OE simultaneously with other surgeries after completion of induction CT was associated with better OS, when compared with performing OE during induction CT.

摘要

目的

经典的睾丸生殖细胞肿瘤（mGCT）治疗方案中，第一步是进行睾丸切除术（OE）。然而，一些患者疾病症状严重，需要立即开始化疗（CT），随后进行 OE。本回顾性分析旨在探讨延迟 OE 对 mGCT 患者生存的影响。

方法和材料

我们分析了 1986 年至 2009 年期间在我院接受治疗的 1483 例晚期 mGCT 患者的 CT 初治数据。71 例（4.8%）患者接受了延迟 OE：8 例（11.2%）为精原细胞瘤，50 例（70.4%）为非精原细胞瘤，13 例（18.4%）肿瘤组织学类型未知。20%、40%和 40%的患者分别属于国际生殖细胞肿瘤共识组（IGCCCG）预后良好、中等和差的分组。从 CT 开始到 OE 的中位时间为 18（范围，1-250）天。OE 分别在第 1 周期（39 例，55%）、第 2 周期至 CT 完成（21 例，29.5%）和诱导 CT 完成后（11 例，15.5%）进行。中位随访时间为 156（范围，3-241）个月。66 例（93%）患者接受依托泊苷和顺铂为基础的 CT。

结果

所有 1483 例患者的 3 年总生存率（OS）为 75%。在完成 CT 后进行 OE 的患者中观察到了极好的肿瘤原发灶反应（n=11）：仅发现成熟畸胎瘤（n=4）和肿瘤坏死（n=7）。延迟 OE 患者的 3 年 OS 为 63%。完成 CT 后进行 OE 与更好的预后相关。第 1 周期（第 1 组）进行延迟 OE 的患者 3 年 OS 为 67%，第 2 周期至 CT 完成（第 2 组）为 39%，完成 CT 后（第 3 组）为 88%（第 1 组与第 3 组：风险比 3.7，95%置信区间 0.69-10.1，P=0.15；第 2 组与第 3 组：P=0.01，风险比 8.1，95%置信区间 1.32-18.72）。似乎如果在 CT 期间进行 OE，则开始下一周期的时间会延迟，CT 的剂量强度会降低。