*Department of Urology, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara, Tochigi 329-2763, Japan.
Jpn J Clin Oncol. 2013 Dec;43(12):1249-54. doi: 10.1093/jjco/hyt152. Epub 2013 Oct 6.
To investigate the dose intensity of induction chemotherapy and oncological outcomes of metastatic testicular cancer under centralized management through a regional medical network.
We retrospectively analyzed the outcomes of 86 metastatic testicular cancer patients who were given induction chemotherapy at Tsukuba University Hospital and four branch hospitals between January 2000 and November 2010. Principally, management of patients with poor-prognosis disease and patients having risk factors for bleomycin, etoposide and cisplatin were referred to Tsukuba University Hospital before chemotherapy. For high-risk groups, etoposide and cisplatin or etoposide, ifosfamide and cisplatin was used as an alternative to bleomycin, etoposide and cisplatin.
Overall, 56 and 30 patients were treated at Tsukuba University Hospital and branch hospitals, respectively. Forty-seven, 18 and 21 patients were classified with good-, intermediate- and poor-prognosis disease, respectively, according to the International Germ Cell Cancer Collaborative Group criteria. Eighteen of the 21 patients (86%) with poor-prognosis disease were treated at Tsukuba University Hospital from the beginning of induction chemotherapy. Induction chemotherapy with a high relative dose intensity was possible in most patients. The average relative dose intensity of each drug was >0.96. Treatment procedures other than induction chemotherapy were efficiently centralized; 74% of post-chemotherapy surgery and all second-line or subsequent chemotherapies were performed at Tsukuba University Hospital. The 5-year overall survival rates of the good-, intermediate- and poor-prognosis groups were 97, 93 and 84%, respectively.
Induction chemotherapy with high relative dose intensity, post-chemotherapy surgery and salvage chemotherapy was accomplished efficiently through centralization of management. Oncological outcomes were excellent, especially in patients with poor-prognosis disease, whose 5-year OS reached 84%.
通过区域医疗网络，研究集中管理下转移性睾丸癌诱导化疗的剂量强度和肿瘤学结局。
我们回顾性分析了 2000 年 1 月至 2010 年 11 月期间在筑波大学医院和四家分院接受诱导化疗的 86 例转移性睾丸癌患者的结局。原则上，在化疗前，将预后不良疾病患者和存在博来霉素、依托泊苷和顺铂治疗危险因素的患者转诊至筑波大学医院。对于高危组，采用依托泊苷和顺铂或依托泊苷、异环磷酰胺和顺铂替代博来霉素、依托泊苷和顺铂。
总体而言，分别有 56 例和 30 例患者在筑波大学医院和分院接受治疗。根据国际生殖细胞癌协作组标准，47 例、18 例和 21 例患者分别归类为预后良好、中等和不良预后疾病。21 例（86%）预后不良患者从诱导化疗开始即在筑波大学医院接受治疗。大多数患者能够进行高相对剂量强度的诱导化疗。每种药物的平均相对剂量强度均>0.96。除诱导化疗外的治疗程序也得到了有效的集中处理；74%的化疗后手术和所有二线或后续化疗均在筑波大学医院进行。预后良好、中等和不良预后组的 5 年总生存率分别为 97%、93%和 84%。
通过集中管理，实现了高相对剂量强度的诱导化疗、化疗后手术和挽救性化疗，疗效显著。肿瘤学结局优异，尤其是预后不良患者，其 5 年 OS 达到 84%。
