Mortensen Mette S, Bandak Mikkel, Kier Maria G G, Lauritsen Jakob, Agerbaek Mads, Holm Niels V, von der Maase Hans, Daugaard Gedske
Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Unit of Survivorship, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark.
Cancer. 2017 Apr 1;123(7):1212-1218. doi: 10.1002/cncr.30458. Epub 2016 Nov 28.
The optimal treatment strategy for patients with clinical stage I (CS-1) seminoma is controversial. The objective of the current study was to evaluate the outcomes for patients considered to be at high risk of disease recurrence with a tumor size ≥6 cm. Patients were treated with either adjuvant radiotherapy (RT) or followed with surveillance.
From the Danish Testicular Cancer database, the authors identified 473 patients with CS-1 seminoma with a tumor size ≥6 cm. Of these, 254 patients underwent adjuvant RT and 219 were followed with surveillance. Cumulative incidence function was applied to estimate the risk of disease recurrence, risk of second malignant neoplasm, and risk of receiving >1 line of treatment. Survival of the 2 groups was compared with the log-rank test and Cox model including age at diagnosis.
No significant differences were found with regard to overall survival or risk of a second malignant neoplasm. Patients undergoing adjuvant RT received more treatments per patient than patients followed with surveillance, but there was no significant difference noted with regard to the risk of receiving >1 line of treatment. The 10-year cumulative incidence of disease recurrence was 32% versus 2.8%, respectively, for patients followed with surveillance and adjuvant RT. In patients followed with surveillance who developed disease recurrence, there was a high incidence of second recurrences after RT.
The 10-year overall survival was found to be similar irrespective of primary treatment. Adjuvant RT was found to effectively reduce the rate of disease recurrence but resulted in the overtreatment of approximately two-thirds of the patients. The high incidence of second disease recurrences after RT in the patients followed with surveillance needs be addressed in future studies. Cancer 2017;123:1212-1218. © 2016 American Cancer Society.
临床I期（CS-1）精原细胞瘤患者的最佳治疗策略存在争议。本研究的目的是评估肿瘤大小≥6 cm、被认为疾病复发风险高的患者的治疗结果。患者接受辅助放疗（RT）或接受观察。
作者从丹麦睾丸癌数据库中识别出473例肿瘤大小≥6 cm的CS-1精原细胞瘤患者。其中，254例患者接受了辅助放疗，219例接受观察。应用累积发病率函数来估计疾病复发风险、第二原发性恶性肿瘤风险和接受>1线治疗的风险。采用对数秩检验和包含诊断时年龄的Cox模型比较两组的生存率。
在总生存率或第二原发性恶性肿瘤风险方面未发现显著差异。接受辅助放疗的患者比接受观察的患者每人接受的治疗更多，但在接受>1线治疗的风险方面未发现显著差异。接受观察和辅助放疗的患者10年疾病复发累积发病率分别为32%和2.8%。在接受观察且出现疾病复发的患者中，放疗后二次复发的发生率较高。
无论初始治疗如何，10年总生存率相似。辅助放疗可有效降低疾病复发率，但导致约三分之二的患者过度治疗。接受观察的患者放疗后疾病二次复发的高发生率需要在未来研究中加以解决。《癌症》2017年；123:1212 - 1218。©2016美国癌症协会
