[I期睾丸精原细胞瘤的监测：20年肿瘤学结果]

Zores T, Mouracade P, Duclos B, Saussine C, Lang H, Jacqmin D

Service de chirurgie urologique, nouvel hôpital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.

Prog Urol. 2015 Apr;25(5):282-7. doi: 10.1016/j.purol.2015.01.009. Epub 2015 Feb 25.

INTRODUCTION AND OBJECTIVE

The objective of this study was to assess the oncological results of a population of patients which undergo surveillance after diagnosis of stage I testicular seminoma (2, 5 and 8 years overall, specific and recurrence free survival). We also research recurrence risk factors.

PATIENTS AND METHODS

We have looked at the data of all patients treated in our center since 1993 for a grade I testicular seminoma. We focused on age at diagnosis, biological (tumoral markers) and pathological (tumor size, rete testis, lymphovascular, tunica albuginea or spermatic cord invasion) data. During surveillance, we noted the number, the localization and the interval until recurrence and death. We calculated 2, 5 and 8 years overall, specific and recurrence-free survival and searched recurrence risk factors.

RESULTS

Sixty-nine patients (mean age: 37) were followed during a mean time of 97 months. Sixty-three per cent of the tumours were less than 4 cm (50 lesions). Lymphovascular, rete testis, spermatic cord and tunica albuginea invasion were present in respectively 21%, 33%, 4% and 29% of the cases. LDH and HCG were above normal rate in respectively 44 and 27% of the cases. Eighteen patients (23%) relapsed at a mean time of 12 months. Recurrence-free survival was respectively 81%, 77% and 77% at 2, 5 and 8 years. Tumor size<4 cm (P = 0.002), rete testis invasion (P = 0.03) and stage ≥ pT2 (P = 0.012) were associated with recurrence in univariate analysis. Using multivariate analysis, only tumor size >4 cm was a recurrence risk factor (risk multiplied by 3). At the end of the study, 77 patients are alive (97.5%). Overall and specific survival was 97.5% at 2, 5 and 8 years.

CONCLUSION

We show here the interest of surveillance in case of stage 1 testicular seminoma. The overall and specific survivals are the same as after chemotherapy or radiotherapy. Furthermore, we confirm the role of tumor size to stratify recurrence risk.

引言与目的

本研究的目的是评估一组I期睾丸精原细胞瘤患者在诊断后接受监测的肿瘤学结果（总体、特异性及无复发生存率，分别为2年、5年和8年）。我们还研究复发风险因素。

患者与方法

我们研究了自1993年以来在本中心接受治疗的所有I级睾丸精原细胞瘤患者的数据。我们关注诊断时的年龄、生物学指标（肿瘤标志物）和病理学指标（肿瘤大小、睾丸网、淋巴管、白膜或精索侵犯情况）。在监测期间，我们记录复发和死亡的数量、部位及间隔时间。我们计算了2年、5年和8年的总体、特异性及无复发生存率，并寻找复发风险因素。

结果

69例患者（平均年龄：37岁）平均随访97个月。63%的肿瘤小于4cm（50个病灶）。分别有21%、33%、4%和29%的病例存在淋巴管、睾丸网、精索和白膜侵犯。44%和27%的病例乳酸脱氢酶（LDH）和人绒毛膜促性腺激素（HCG）高于正常水平。18例患者（23%）复发，平均复发时间为12个月。2年、5年和8年的无复发生存率分别为81%、77%和77%。单因素分析显示，肿瘤大小<4cm（P = 0.002）、睾丸网侵犯（P = 0.03）和分期≥pT2（P = 0.012）与复发相关。多因素分析显示，只有肿瘤大小>4cm是复发风险因素（风险乘以3）。研究结束时，77例患者存活（97.5%）。2年、5年和8年的总体及特异性生存率均为97.5%。