Richie J P, Socinsky M A, Fung C Y, Brodsky G L, Kalish L A, Garnick M B
Department of Surgery/Urology, Brigham and Women's Hospital, Boston, MA 02115.
Arch Surg. 1987 Dec;122(12):1443-5. doi: 10.1001/archsurg.1987.01400240091016.
Eighty patients with clinical stage I or II nonseminomatous germ cell tumors of the testis were managed with modified protocols, including modified nerve-sparing retroperitoneal lymph node dissection for patients with stage I cancer, retroperitoneal lymph node dissection for patients with low-volume stage II cancer, and initial chemotherapy with or without subsequent retroperitoneal lymphadenectomy for patients with high-volume stage II cancer. Patients with low-stage disease (clinical stage I) were treated successfully with modified retroperitoneal lymph node dissection (relapse rate, three of 40 patients). Clinical understaging was evidenced in 14 of 48 patients with clinical stage I disease who were found to have pathologic involvement of the retroperitoneal lymph nodes, including six patients with extensive retroperitoneal nodal involvement (pathologic stage B2). Of nine patients with retroperitoneal tumors less than 3 cm in diameter, four patients were satisfactorily treated with retroperitoneal lymph node dissection alone while five patients required chemotherapy after retroperitoneal lymph node dissection. Of 26 patients with retroperitoneal tumors 3 to 5 cm in diameter, 17 patients were treated with chemotherapy alone. All patients remain free of disease after the completion of definitive therapy. We conclude that therapeutic options should be modified based on histologic factors in the primary tumor, extent of retroperitoneal disease as indicated on a computed tomographic scan, and presence or absence of elevated tumor markers. By consideration these factors, optimum therapy can be selected to achieve the highest long-term survival rate with the least morbidity.
80例临床分期为I期或II期的睾丸非精原细胞瘤患者采用改良方案进行治疗，包括对I期癌症患者行改良保留神经的腹膜后淋巴结清扫术，对低负荷II期癌症患者行腹膜后淋巴结清扫术，对高负荷II期癌症患者先行化疗，后续根据情况决定是否行腹膜后淋巴结切除术。低分期疾病（临床I期）患者采用改良腹膜后淋巴结清扫术治疗效果良好（40例患者中有3例复发）。48例临床I期疾病患者中有14例存在腹膜后淋巴结病理受累，提示临床分期不准确，其中6例患者腹膜后淋巴结广泛受累（病理分期B2）。9例直径小于3 cm的腹膜后肿瘤患者中4例仅行腹膜后淋巴结清扫术即获得满意治疗，另5例患者在腹膜后淋巴结清扫术后需要化疗。26例直径3至5 cm的腹膜后肿瘤患者中，17例仅接受化疗。所有患者在完成确定性治疗后均无疾病复发。我们得出结论，应根据原发肿瘤的组织学因素、计算机断层扫描显示的腹膜后疾病范围以及肿瘤标志物是否升高来调整治疗方案。综合考虑这些因素，可以选择最佳治疗方法，以实现最高的长期生存率并降低发病率。
