Beck Stephen Dw
Department of Urology, Indiana University, Indianapolis, Indiana, USA.
Open Access J Urol. 2010 Aug 12;2:143-54.
Germ-cell cancer is the most common solid tumor in men aged 15 to 35 years and has become the model for curable neoplasm. Over the last 3 decades, the cure rate has increased from 15% to 85%. This improved cure rate has been largely attributed to the introduction of cisplatin-based chemotherapy. In stage I seminoma and nonseminoma, cure rates approach 100% and treatment is governed by patient choice based on the perceived morbidities of each therapy and personal preferences. For seminoma, treatments include surveillance, radiotherapy, and single course carboplatin. For nonseminoma, treatments include surveillance, retroperitoneal lymph node dissection (RPLND), and adjuvant chemotherapy. Low volume (<3 cm) stage II seminoma is typically managed with radiotherapy while higher volume (>3 cm) stage II and stage III disease treated with chemotherapy. Positron emission tomography (PET) imaging can differentiate active cancer versus necrosis for postchemotherapy residual masses. PET-positive masses are managed with either surgery or second-line chemotherapy. Low volume (<5 cm) stage II nonseminoma with normal serum tumor markers may be managed with either RPLND or chemotherapy. Patients with persistently elevated serum tumor markers and larger volume stage II and stage III disease are managed with systemic chemotherapy. As with seminoma, good risk patients are typically treated with 3 courses of bleomycin, etoposide, and cisplatin (BEP) and intermediate and poor risk patients are treated with 4 courses. Residual postchemotherapy masses should be resected due to the uncertainty of the histology with 50% to 60% harboring residual teratoma or active cancer. The majority of patients completing initial therapy who relapse do so within 2 years. A minority of patients (2%-3%) recur after 2 years and this phenomenon is termed late relapse. Excluding chemonaïve patients, late relapse disease is typically managed surgically with 50% being cured of disease. Current therapeutic challenges in testis cancer include the accurate prediction of postchemotherapy histology to avoid surgery in patients harboring fibrosis only, improved therapy in platinum-resistant and platinum-refractory disease, and the understanding of the biology of late relapse.
生殖细胞癌是15至35岁男性中最常见的实体瘤，已成为可治愈肿瘤的典范。在过去30年中，治愈率从15%提高到了85%。治愈率的提高很大程度上归功于以顺铂为基础的化疗的引入。在I期精原细胞瘤和非精原细胞瘤中，治愈率接近100%，治疗方式由患者根据对每种疗法的感知发病率和个人偏好来选择。对于精原细胞瘤，治疗方法包括监测、放疗和单疗程卡铂治疗。对于非精原细胞瘤，治疗方法包括监测、腹膜后淋巴结清扫术（RPLND）和辅助化疗。低体积（<3 cm）的II期精原细胞瘤通常采用放疗，而高体积（>3 cm）的II期和III期疾病则采用化疗。正电子发射断层扫描（PET）成像可区分化疗后残留肿块中的活性癌与坏死。PET阳性肿块可通过手术或二线化疗进行处理。血清肿瘤标志物正常的低体积（<5 cm）II期非精原细胞瘤可采用RPLND或化疗。血清肿瘤标志物持续升高以及高体积的II期和III期疾病患者采用全身化疗。与精原细胞瘤一样，低风险患者通常接受3个疗程的博来霉素、依托泊苷和顺铂（BEP）治疗，中风险和高风险患者接受四个疗程的治疗。化疗后残留肿块应进行切除，因为其组织学情况不确定，50%至60%的肿块含有残留畸胎瘤或活性癌。大多数完成初始治疗后复发的患者在2年内复发。少数患者（2%-3%）在2年后复发，这种现象称为晚期复发。除了初治患者外，晚期复发性疾病通常采用手术治疗。50%的患者可治愈。睾丸癌目前的治疗挑战包括准确预测化疗后的组织学情况，以避免仅患有纤维化的患者接受手术，改善对铂耐药和铂难治性疾病的治疗，以及了解晚期复发的生物学机制。
