Favilla Vincenzo, Russo Giorgio Ivan, Spitaleri Fabio, Urzì Daniele, Garau Marco, Madonia Massimo, Saita Alberto, Pirozzi Farina Furio, La Vignera Sandro, Condorelli Rosita, Calogero Aldo E, Cimino Sebastiano, Morgia Giuseppe
Department of Urology, School of Medicine Policlinico Hospital, University of Catania, Catania, Italy.
Int Urol Nephrol. 2014 Jun;46(6):1131-5. doi: 10.1007/s11255-013-0617-6. Epub 2013 Dec 7.
The aim of the study is to determine the association between multifocality and the pathological features of testicular germ cell tumors and its clinical implication.
Orchiectomy specimens from 254 consecutive patients with testis cancer between 2003 and 2013 were included. Multifocality was defined as a distinct tumor focus of cluster of malignant cells > 0.5 mm and separable from the main tumor mass. Univariate logistic regression analysis was performed to evaluate the association between multifocality and other pathological features. Multivariate logistic regression analyses were carried out to identify potential predictive factors of multifocality for clinical stages II-III and the pathological stage ≥ pT2.
Median patient age was 33 years (range 19-70). Multifocality was identified in 58 (22.83 %) orchiectomy specimens. Subjects with multifocality had larger primary tumor lesions (3.7 vs. 3.0 cm; p < 0.05). No association was found between histology and multifocality (p = 0.95). On univariate logistic regression analysis, multifocality was not significantly associated with all pathological features. On multivariate logistic regression analysis, multifocality was not demonstrated to be an adverse pathological feature of clinical stages II-III (p = 0.23) or pathological stage ≥ pT2 (p = 0.30) when included in a model with tumor size ≥ 4 cm and rete testis invasion in seminoma tumor and neither of clinical stages II-III (p = 0.36) or pathological stage ≥ pT2 (p = 0.20) when included in a model with lymphovascular invasion and percentage of embrional cancer ≥ 50 % in non-seminoma ones.
Multifocality should not be considered an adverse pathological feature in patients with testis cancer, independently to histological subtypes.
本研究旨在确定睾丸生殖细胞肿瘤的多灶性与其病理特征之间的关联及其临床意义。
纳入2003年至2013年间连续254例睾丸癌患者的睾丸切除标本。多灶性定义为恶性细胞簇形成的明显肿瘤灶，直径>0.5 mm，且与主要肿瘤块可分离。进行单因素逻辑回归分析以评估多灶性与其他病理特征之间的关联。进行多因素逻辑回归分析以确定临床II - III期和病理分期≥pT2的多灶性潜在预测因素。
患者中位年龄为33岁（范围19 - 70岁）。在58例（22.83%）睾丸切除标本中发现多灶性。有多灶性的患者原发性肿瘤病变更大（3.7对3.0 cm；p < 0.05）。未发现组织学与多灶性之间存在关联（p = 0.95）。单因素逻辑回归分析显示，多灶性与所有病理特征均无显著关联。多因素逻辑回归分析表明，当与精原细胞瘤中肿瘤大小≥4 cm和睾丸网侵犯或非精原细胞瘤中淋巴管侵犯及胚胎癌百分比≥50%纳入同一模型时，多灶性并非临床II - III期（p = 0.23）或病理分期≥pT2（p = 0.30）的不良病理特征。
对于睾丸癌患者，无论组织学亚型如何，多灶性均不应被视为不良病理特征。
