Som Avik, Xiao Li, Zhu Rui, Guo Charles C, Xiao Lianchun, Rao Priya, Efstathiou Eleni, Matin Angabin, Tu Shi-Ming
Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030-3721, USA.
Can J Urol. 2013 Aug;20(4):6860-7.
A small subset of young men die from seminoma. Studying these high risk, clinically atypical seminomas (CASs)-aggressive tumors with visceral metastases and chemotherapy resistance-may provide clues to the nature of drug resistance and the origin of testicular cancers. We explored the possibility that these seminomas are a unique clinical and biologic entity with intrinsic yolk sac tumor (YST) features.
We assayed available archived tissue samples (n = 22) for chemotherapy-resistance markers found in YSTs. Specifically, we analyzed tissues and clinical histories from patients with CASs (those who had visceral metastases and recurrent disease), classical seminomas, and mixed germ-cell tumors containing YST. By using immunohistochemical testing, we evaluated the expression of bone morphogenetic protein 2, alpha fetoprotein, and glutathione S-transferase (pi) [GST (pi)].
GST (pi) expression significantly predicted for overall survival (p = .036). In addition, according to the results of GST (pi) immunohistochemical staining, the CASs appeared to resemble YSTs more than they did classical seminomas (p = 0.043). Less-advanced tumors, both those that expressed GST (pi) and those that were negative for GST (pi), were more amenable to local therapies, and the patients who had those tumors had better clinical outcomes.
Results from this exploratory study suggest that certain CASs that express GST (pi) are more similar to YST than they are to classical seminomas, and that GST (pi) expression may be able to be used as a prognosticator of disease-specific survival. Such CASs thus may have a unique biologic origin that differs from that of classical seminomas. Additional studies are needed to determine the natural history and therapeutic implications of these CASs.
一小部分年轻男性死于精原细胞瘤。研究这些具有高风险、临床非典型性的精原细胞瘤（CASs）——伴有内脏转移和化疗耐药性的侵袭性肿瘤——可能为耐药性的本质和睾丸癌的起源提供线索。我们探讨了这些精原细胞瘤是具有内在卵黄囊瘤（YST）特征的独特临床和生物学实体的可能性。
我们检测了现有的存档组织样本（n = 22）中YSTs中发现的化疗耐药标志物。具体而言，我们分析了患有CASs（有内脏转移和复发性疾病的患者）、经典精原细胞瘤以及含有YST的混合性生殖细胞肿瘤患者的组织和临床病史。通过免疫组织化学检测，我们评估了骨形态发生蛋白2、甲胎蛋白和谷胱甘肽S转移酶（pi）[GST（pi）]的表达。
GST（pi）表达显著预测总生存期（p = 0.036）。此外，根据GST（pi）免疫组织化学染色结果，CASs似乎比经典精原细胞瘤更类似于YSTs（p = 0.043）。进展程度较低的肿瘤，无论是表达GST（pi）的肿瘤还是GST（pi）阴性的肿瘤，对局部治疗的耐受性更好，患有这些肿瘤的患者临床结局更佳。
这项探索性研究的结果表明，某些表达GST（pi）的CASs与YST的相似性高于与经典精原细胞瘤的相似性，并且GST（pi）表达可能能够用作疾病特异性生存的预后指标。因此，此类CASs可能具有与经典精原细胞瘤不同的独特生物学起源。需要进一步的研究来确定这些CASs的自然病史和治疗意义。
