Thomas G M, Sturgeon J F, Alison R, Jewett M, Goldberg S, Sugar L, Rideout D, Gospodarowicz M K, Duncan W
Toronto Bayview Regional Cancer Clinic, Ontario, Canada.
J Urol. 1989 Aug;142(2 Pt 1):313-6. doi: 10.1016/s0022-5347(17)38742-6.
A study of post-orchiectomy surveillance without radiation therapy was done in patients with histologically pure seminoma apparently confined to the testicle. Criteria for study entry included a negative physical examination, chest x-ray, bipedal lymphogram, excretory urogram, abdomino-pelvic computerized tomography scan and serum alpha-fetoprotein. Followup consisted of frequent clinical examination, repeat lymphograms, abdominal computerized tomography scans, chest x-rays and serum markers. The purpose of this study was to determine the percentage of patients cured by orchiectomy alone, percentage who ultimately required therapy for occult metastases beyond the testicle, sites of relapse, factors predictive of relapse, and over-all cure rate and treatment morbidity. Of 81 patients followed for 3 to 43 months (median 19 months) only 3 had relapse at 3, 5 and 18 months after orchiectomy with nonbulky retroperitoneal disease: 1 patient had disease 17 months after salvage infradiaphragmatic radiation therapy, 1 had an increase in beta-human chorionic gonadotropin 11 months after radiation therapy, presumably due to occult nonseminoma, and he is receiving chemotherapy, and 1 has not yet completed treatment. Further followup is necessary to determine ultimate survival, since a risk for later relapse exists. However, to date it does not appear as if the outcome has been compromised when surveillance was applied in place of routine adjuvant radiotherapy.
对组织学上为纯精原细胞瘤且明显局限于睾丸的患者进行了一项不进行放射治疗的睾丸切除术后监测研究。研究入选标准包括体格检查阴性、胸部X光、双侧淋巴造影、排泄性尿路造影、腹盆腔计算机断层扫描以及血清甲胎蛋白。随访包括频繁的临床检查、重复淋巴造影、腹部计算机断层扫描、胸部X光以及血清标志物检查。本研究的目的是确定仅通过睾丸切除术治愈的患者百分比、最终需要对睾丸外隐匿转移灶进行治疗的患者百分比、复发部位、复发预测因素、总体治愈率以及治疗发病率。在81例随访3至43个月（中位时间19个月）的患者中，仅3例在睾丸切除术后3、5和18个月出现复发，伴有非巨大的腹膜后疾病：1例患者在膈下挽救性放射治疗17个月后出现疾病复发，1例在放射治疗11个月后β-人绒毛膜促性腺激素升高，推测是由于隐匿性非精原细胞瘤，他正在接受化疗，还有1例尚未完成治疗。由于存在后期复发风险，需要进一步随访以确定最终生存率。然而，迄今为止，当采用监测代替常规辅助放疗时，结果似乎并未受到影响。
