Ondruš D, Ondrušová M, Št'astná V
Klin Onkol. 2013;26(6):421-4. doi: 10.14735/amko2013421.
Germ cell testicular cancer (TC) patients have an increased risk of developing a contralateral TC. This paper presents a retrospective analysis of patients with bilateral TC from a database of a single center and aims to highlight the need for an individual approach.
In the study period from January 1970 to June 2013, a total of 1,438 patients with primary TC were diagnosed. The group comprised of 1,370 patients with unilateral TC and 68 patients with bilateral TC. Bilateral TC patients were evaluated regarding the age at presentation and the histology of tumor and then compared with the group of patients with unilate-ral TC.
The mean age of the patients with unilateral TC was 31.7 years. This group of patients consisted of 408 patients with seminoma and 962 patients with non-seminomatous TC. The group of 68 patients with bilateral TC involved 63 patients with metachronous disease and five patients who developed TCs simultaneously. The mean age at diagnosis of primary tumor in patients with metachronous bilateral TC (25.8 years) was significantly earlier in comparison to patients with unilateral disease. Among 24 patients with seminoma there were 17 patients who subsequently developed a second malignancy of an identical histological type. In the group of 39 patients with initial non-seminomatous TC there were 15 patients with discordant histology of the second tumor. In the metachronous disease group, patients with primary seminoma were significantly older than those with initial non-seminomas.
All patients with unilateral TC have an increased risk of developing a contralateral TC, years and even decades after the initial diagnosis. Management of subsequent TC should be individualized for each patient according to the histology and clinical stage of the primary tumor, as well as the therapeutic strategy applied initially. The further management should involve a long-term follow-up and life-long testosterone substitution.
睾丸生殖细胞癌（TC）患者发生对侧TC的风险增加。本文对来自单一中心数据库的双侧TC患者进行回顾性分析，旨在强调个体化治疗方法的必要性。
在1970年1月至2013年6月的研究期间，共诊断出1438例原发性TC患者。该组包括1370例单侧TC患者和68例双侧TC患者。对双侧TC患者的就诊年龄和肿瘤组织学进行评估，然后与单侧TC患者组进行比较。
单侧TC患者的平均年龄为31.7岁。该组患者包括408例精原细胞瘤患者和962例非精原细胞瘤性TC患者。68例双侧TC患者中，63例为异时性疾病，5例同时发生TC。异时性双侧TC患者原发性肿瘤诊断时的平均年龄（25.8岁）明显早于单侧疾病患者。在24例精原细胞瘤患者中，有17例随后发生了相同组织学类型的第二种恶性肿瘤。在39例初始为非精原细胞瘤性TC的患者中，有15例第二种肿瘤的组织学不一致。在异时性疾病组中，原发性精原细胞瘤患者明显比初始为非精原细胞瘤患者年龄大。
所有单侧TC患者在初始诊断后的数年甚至数十年内发生对侧TC的风险均增加。后续TC的管理应根据原发性肿瘤的组织学和临床分期以及最初应用的治疗策略对每位患者进行个体化。进一步的管理应包括长期随访和终身睾酮替代治疗。
