Logothetis C J, Samuels M L, Selig D E, Dexeus F H, Johnson D E, Swanson D A, von Eschenbach A C
J Clin Oncol. 1985 Mar;3(3):316-25. doi: 10.1200/JCO.1985.3.3.316.
Forty-nine patients with histologically proven germ cell tumors arising in extragonadal sites were retrospectively reviewed. Included in the review were an additional seven patients with undifferentiated tumors with a pathologic appearance compatible with that of a germ cell tumor and elevated levels of serum biomarkers (beta subunit of human chorionic gonadotropin [beta-HCG] +/- alpha-fetoprotein [AFP]. Nineteen patients had a pure seminoma arising in an extragonadal site, whereas 30 patients had nonseminomatous germ cell tumors. Seven patients had primary undifferentiated tumors with elevated levels of serum biomarkers. Sixteen (84%) of the 19 patients with pure extragonadal seminomas with normal levels of serum AFP are alive and free of disease. Eighteen of these 19 patients received platinum-containing regimens and four had received prior chemotherapy that failed. Of the patients with nonseminomatous germ cell tumors, 12 (40%) of the 30 are alive and free of disease with vinblastine/bleomycin +/- cisplatin (13 patients) or CISCAII (cisplatin, cyclophosphamide, and doxorubicin) (nine patients) alternating CISCAII/VBIV (eight patients) chemotherapy. None of the seven patients with undifferentiated germ cell tumors are alive and free of disease. Three of the five patients with pure anterior mediastinal endodermal sinus tumors treated with chemotherapy remain alive and free of disease. Of the seven patients with choriocarcinomas arising in extragonadal sites, three are alive and free of disease. A classification for patients with extragonadal germ cell tumors incorporating site of origin, histology, and likelihood of being truly extragonadal is proposed. The implications of this classification are discussed.
对49例经组织学证实的发生于性腺外部位的生殖细胞肿瘤患者进行了回顾性研究。该回顾还纳入了另外7例未分化肿瘤患者，其病理表现与生殖细胞肿瘤相符，且血清生物标志物（人绒毛膜促性腺激素β亚基[β-HCG]+/-甲胎蛋白[AFP]）水平升高。19例患者为性腺外部位的纯精原细胞瘤，30例患者为非精原细胞性生殖细胞肿瘤。7例患者为血清生物标志物水平升高的原发性未分化肿瘤。19例血清AFP水平正常的性腺外纯精原细胞瘤患者中，16例（84%）存活且无疾病。这19例患者中有18例接受了含铂方案治疗，4例曾接受过失败的化疗。在非精原细胞性生殖细胞肿瘤患者中，30例中有12例（40%）存活且无疾病，接受了长春碱/博来霉素+/-顺铂（13例患者）或CISCAII（顺铂、环磷酰胺和阿霉素）（9例患者）交替CISCAII/VBIV（8例患者）化疗。7例未分化生殖细胞肿瘤患者均无存活且无疾病。5例接受化疗的纯前纵隔内胚窦瘤患者中有3例仍存活且无疾病。在7例发生于性腺外部位的绒毛膜癌患者中，3例存活且无疾病。提出了一种针对性腺外生殖细胞肿瘤患者的分类方法，该分类方法纳入了起源部位、组织学类型以及真正性腺外的可能性。并讨论了该分类方法的意义。
