Division of Urologic Oncology, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Urology, University of Colorado School of Medicine, Aurora, Colorado.
Division of Urologic Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
J Urol. 2014 May;191(5 Suppl):1485-90. doi: 10.1016/j.juro.2013.08.047. Epub 2014 Mar 26.
The COG (Children's Oncology Group) currently recommends surveillance for all children and adolescents with clinical stage I testicular germ cell tumors. However, up to 30% of adults with clinical stage I testicular germ cell tumors harbor occult metastatic disease. In adults with clinical stage I nonseminoma some groups advocate a risk stratified approach. Occult metastases were noted in 50% of patients with features such as lymphovascular invasion or embryonal carcinoma predominance in the orchiectomy. However, to our knowledge there are no data on the impact of high risk features in such pubertal children and postpubertal adolescents.
We reviewed an institutional testis cancer database for pubertal children and postpubertal adolescents younger than 21 years. We tested the hypothesis that lymphovascular invasion, or 40% or greater embryonal carcinoma in the orchiectomy specimen, would increase the risk of occult metastases, ie relapse during surveillance or positive nodes on retroperitoneal lymph node dissection.
We identified 23 patients with a median age of 18.6 years (range 7.1 to 20.9) at diagnosis. Of these patients 14 (60.9%) were on surveillance, 9 (39.1%) underwent primary retroperitoneal lymph node dissection and none received initial chemotherapy. Seven patients (30.4%) had occult metastatic disease. High risk pathological features were found in the orchiectomy specimen in 12 patients (52.2%), including all 12 (52.2%) with 40% or greater embryonal carcinoma and 3 (13.0%) with lymphovascular invasion. Seven patients (58.3%) with high risk features had occult metastatic disease vs none (0%) without high risk features (log rank p = 0.031).
Approximately half of pubertal children and postpubertal adolescents with high risk clinical stage I testicular germ cell tumors harbor occult metastatic disease. These results may be useful when discussing prognosis and treatment with patients and families.
COG（儿童肿瘤学组）目前建议对所有临床 I 期睾丸生殖细胞肿瘤患儿和青少年进行监测。然而，多达 30%的临床 I 期睾丸生殖细胞肿瘤成人存在隐匿性转移疾病。在临床 I 期非精原细胞瘤成人中，一些研究组主张采用风险分层方法。在接受睾丸切除术的患者中，具有血管淋巴管侵犯或胚胎癌优势等特征的患者中，有 50%的患者存在隐匿性转移。然而，据我们所知，目前尚无关于青春期前儿童和青春期后青少年此类高危特征的影响的数据。
我们对一个机构的睾丸癌数据库进行了回顾，以纳入年龄小于 21 岁的青春期前儿童和青春期后青少年。我们检验了如下假设：即睾丸切除术标本中存在血管淋巴管侵犯或 40%以上的胚胎癌会增加隐匿性转移的风险，即监测期间复发或腹膜后淋巴结清扫时出现阳性淋巴结。
我们共确定了 23 例患者，中位年龄为 18.6 岁（范围 7.1 至 20.9 岁）。其中 14 例（60.9%）接受监测，9 例（39.1%）接受了原发性腹膜后淋巴结清扫，无初始化疗。7 例（30.4%）存在隐匿性转移疾病。12 例（52.2%）患者的睾丸切除术标本中存在高危病理特征，包括 12 例（52.2%）胚胎癌比例达到或超过 40%和 3 例（13.0%）血管淋巴管侵犯。7 例（58.3%）存在高危特征的患者存在隐匿性转移疾病，而无高危特征的患者中无一例（0%）存在隐匿性转移疾病（对数秩检验，p=0.031）。
约一半的具有高危临床 I 期睾丸生殖细胞肿瘤的青春期前儿童和青春期后青少年存在隐匿性转移疾病。这些结果可能有助于与患者及其家属讨论预后和治疗。
