Nakamura Terukazu, Oishi Masakatsu, Ueda Takashi, Fujihara Atsuko, Nakanishi Hiroyuki, Kamoi Kazumi, Naya Yoshio, Hongo Fumiya, Okihara Koji, Miki Tsuneharu
Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Int J Urol. 2015 Jul;22(7):663-8. doi: 10.1111/iju.12760. Epub 2015 Apr 6.
To assess clinical outcomes of patients with advanced germ cell tumor undergoing post-chemotherapy retroperitoneal lymph node dissection with or without extraretroperitoneal mass resection.
Between 1998 and 2013, 175 retroperitoneal lymph node dissections for advanced metastatic germ cell tumors were carried out at Kyoto Prefectural University of Medicine, Kyoto, Japan. Of patients receiving retroperitoneal lymph node dissections, 156 underwent post-chemotherapy retroperitoneal lymph node dissection with or without extraretroperitoneal mass resection as first surgery after completion of chemotherapy. Of these 156 patients, 47 underwent both post-chemotherapy retroperitoneal lymph node dissection and extraretroperitoneal mass resection.
The histological findings were necrosis in 59.6%, teratoma in 31.4% and viable cancer in 9.0% at retroperitoneal lymph node. At extraretroperitoneal mass resection, necrosis was present in 59.6%, teratoma in 31.9% and viable cancer in 8.5%. Overall histological discordance between retroperitoneal lymph node and extraretroperitoneal mass was found in 31.9%. Five-year disease-free survival stratified by retroperitoneal lymph node histology in 156 patients was 91.3% for necrosis, 78.7% for teratoma and 63.5% for viable cancer (log-rank, P = 0.009). Antegrade ejaculation was preserved in 80.9%. In the worst histology of post-chemotherapy retroperitoneal lymph node dissection or extraretroperitoneal mass resection in 156 patients, 5-year disease-free survival was 93.2% for necrosis, 79.0% for teratoma and 63.4% for viable cancer (log-rank, P < 0.001). Independent prognostic factors for disease-free survival were presence of viable cancer in retroperitoneal lymph node histology and salvage chemotherapy.
The presence of viable cancer at the retroperitoneal lymph node is an independent predictor of disease recurrence. In approximately one-third of cases, there is a histological discordance between retroperitoneal lymph node and extraretroperitoneal mass. Resection of residual retroperitoneal lymph node and extraretroperitoneal masses remains an important procedure in the management of advanced germ cell tumors.
评估接受化疗后腹膜后淋巴结清扫术（无论是否切除腹膜后间隙肿物）的晚期生殖细胞肿瘤患者的临床结局。
1998年至2013年期间，日本京都府立医科大学对175例晚期转移性生殖细胞肿瘤患者实施了腹膜后淋巴结清扫术。在接受腹膜后淋巴结清扫术的患者中，156例在化疗结束后作为首次手术接受了化疗后腹膜后淋巴结清扫术，无论是否切除腹膜后间隙肿物。在这156例患者中，47例同时接受了化疗后腹膜后淋巴结清扫术和腹膜后间隙肿物切除术。
腹膜后淋巴结的组织学检查结果显示，坏死占59.6%，畸胎瘤占31.4%，存活癌占9.0%。在腹膜后间隙肿物切除术中，坏死占59.6%，畸胎瘤占31.9%，存活癌占8.5%。腹膜后淋巴结与腹膜后间隙肿物之间总体组织学不一致的情况占31.9%。156例患者按腹膜后淋巴结组织学分层的5年无病生存率，坏死组为91.3%，畸胎瘤组为78.7%，存活癌组为63.5%（对数秩检验，P = 0.009）。顺行射精功能保留率为80.9%。在156例患者化疗后腹膜后淋巴结清扫术或腹膜后间隙肿物切除术的最差组织学类型中，坏死组的5年无病生存率为93.2%，畸胎瘤组为79.0%，存活癌组为63.4%（对数秩检验，P < 0.001）。无病生存的独立预后因素是腹膜后淋巴结组织学中存在存活癌和挽救性化疗。
腹膜后淋巴结中存在存活癌是疾病复发的独立预测因素。在大约三分之一的病例中，腹膜后淋巴结与腹膜后间隙肿物之间存在组织学不一致。切除残留的腹膜后淋巴结和腹膜后间隙肿物仍然是晚期生殖细胞肿瘤治疗中的重要步骤。
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