Rescorla Frederick J, Ross Jonathan H, Billmire Deborah F, Dicken Bryan J, Villaluna Doojduen, Davis Mary M, Krailo Mark, Cullen John W, Olson Thomas A, Egler Rachel A, Amatruda James F, Rodrigues-Galindo Carlos, Frazier A Lindsey
Indiana University School of Medicine, USA.
University Hospital Rainbow Babies and Children's Hospital, USA.
J Pediatr Surg. 2015 Jun;50(6):1000-3. doi: 10.1016/j.jpedsurg.2015.03.026. Epub 2015 Mar 14.
The purpose of this study was to determine prognostic factors correlating with outcome in boys with Stage I malignant testicular germ cell tumors (MTGCT) initially managed with surveillance after surgical resection.
Between November 2003 and July 2011, 80 boys 0-15 years with Stage I MTGCT were enrolled in Children's Oncology Group Study AGCT0132. Those with residual or recurrent disease were treated with chemotherapy.
Characteristics include: age (65, 0-5 years and 15, 11+years), pure YST (93.9%, 0-5 years and 0%, 11+years); and lymphovascular invasion (LVI) (50.6% present vs. 49.4% absent). At median follow-up of 4.94 years, 19 had persistent or recurrent disease, all detected by elevated AFP at a median of 87 days after study enrollment. The outcome from enrollment was 4-year EFS 74% (95% CI: 63%-83%) and 4-year OS 100%. 4-year EFS was improved with younger age (<11 years, 80% vs. 11+years, 48%, p<0.01); pure YST vs. mixed histology (81% vs. 45%, p<0.01), and lack of LVI (84% vs. 62%, p=0.03).
Boys with Stage I MTGCT have excellent overall survival when treated with surgery alone. Age greater than 10 years, mixed histology and presence of LVI are each associated with relapse and may allow identification of high risk boys at time of enrollment.
本研究旨在确定与I期恶性睾丸生殖细胞肿瘤（MTGCT）男孩手术切除后初始接受观察等待治疗的预后相关因素。
2003年11月至2011年7月，80名0 - 15岁的I期MTGCT男孩参加了儿童肿瘤学组研究AGCT0132。那些有残留或复发性疾病的患者接受化疗。
特征包括：年龄（65名0 - 5岁，15名11岁及以上），纯卵黄囊瘤（93.9%，0 - 5岁；0%，11岁及以上）；以及淋巴管浸润（LVI）（存在50.6% vs.不存在49.4%）。中位随访4.94年时，19名患者出现持续或复发性疾病，均在研究入组后中位87天通过甲胎蛋白升高检测到。从入组开始的结果为4年无事件生存率（EFS）74%（95%CI：63% - 83%）和4年总生存率（OS）100%。年龄较小（<11岁，80% vs. 11岁及以上，48%，p<0.01）、纯卵黄囊瘤与混合组织学（81% vs. 45%，p<0.01）以及无LVI（84% vs. 62%，p = 0.03）时，4年EFS得到改善。
I期MTGCT男孩仅接受手术治疗时总体生存率良好。年龄大于10岁、混合组织学和LVI的存在均与复发相关，可能有助于在入组时识别高危男孩。
