Lu Su-Ying, Sun Xiao-Fei, Zhen Zi-Jun, Qin Zi-Ke, Liu Zhuo-Wei, Zhu Jia, Wang Juan, Sun Fei-Fei
State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, P. R. China; Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China.
Chin J Cancer. 2015 Feb;34(2):86-93. doi: 10.5732/cjc.014.10027. Epub 2014 Oct 17.
For children with stage II testicular malignant germ cell tumors (MGCT), the survival is good with surgery and adjuvant chemotherapy. However, there is limited data on surgical results for cases in which there was no imaging or pathologic evidence of residual tumor, but in which serum tumor markers either increased or failed to normalize after an appropriate period of half-life time post-surgery. To determine the use of chemotherapy for children with stage II germ cell tumors, we analyzed the outcomes (relapse rate and overall survival) of patients who were treated at the Sun Yat-sen University Cancer Center between January 1990 and May 2013. Twenty-four pediatric patients with a median age of 20 months (range, 4 months to 17 years) were enrolled in this study. In 20 cases (83.3%), the tumors had yolk sac histology. For definitive treatment, 21 patients underwent surgery alone, and 3 patients received surgery and adjuvant chemotherapy. No relapse was observed in the 3 patients who received adjuvant chemotherapy, whereas relapse occurred in 16 of the 21 patients (76.2%) treated with surgery alone. There were a total of 2 deaths. Treatment was stopped for 1 patient, who died 3 months later due to the tumor. The other patient achieved complete response after salvage treatment, but developed lung and pelvic metastases 7 months later and died of the tumor after stopping treatment. For children treated with surgery alone and surgery combined with adjuvant chemotherapy, the 3-year event-free survival rates were 23.8% and 100%, respectively (P = 0.042), and the 3-year overall survival rates were 90.5% and 100%, respectively (P = 0.588). These results suggest that adjuvant chemotherapy can help to reduce the recurrence rate and increase the survival rate for patients with stage II germ cell tumors.
对于Ⅱ期睾丸恶性生殖细胞肿瘤（MGCT）患儿，手术联合辅助化疗的生存率良好。然而，对于那些没有影像学或病理学残留肿瘤证据，但术后经过适当半衰期时间后血清肿瘤标志物升高或未恢复正常的病例，手术结果的数据有限。为了确定Ⅱ期生殖细胞肿瘤患儿化疗的应用，我们分析了1990年1月至2013年5月在中山大学肿瘤防治中心接受治疗的患者的结局（复发率和总生存率）。本研究纳入了24例中位年龄为20个月（范围4个月至17岁）的儿科患者。20例（83.3%）肿瘤具有卵黄囊组织学特征。对于确定性治疗，21例患者仅接受了手术，3例患者接受了手术及辅助化疗。接受辅助化疗的3例患者未观察到复发，而仅接受手术治疗的21例患者中有16例（76.2%）复发。共有2例死亡。1例患者停止治疗，3个月后因肿瘤死亡。另1例患者在挽救治疗后达到完全缓解，但7个月后出现肺和盆腔转移，停止治疗后死于肿瘤。对于仅接受手术和手术联合辅助化疗的患儿，3年无事件生存率分别为23.8%和100%（P = 0.042），3年总生存率分别为90.5%和100%（P = 0.588）。这些结果表明，辅助化疗有助于降低Ⅱ期生殖细胞肿瘤患者的复发率并提高生存率。
