Socinski M A, Garnick M B, Stomper P C, Fung C Y, Richie J P
Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
J Urol. 1988 Dec;140(6):1437-41. doi: 10.1016/s0022-5347(17)42067-2.
The management of patients with nonseminomatous germ cell tumors of the testis and low volume retroperitoneal disease remains controversial. We analyzed the treatment modalities of 56 patients divided into 3 groups: group I--18 clinical stage I cancer patients who had pathological stage II disease after retroperitoneal lymph node dissection, group II--31 patients with abdominopelvic computerized tomography abnormalities of 5 cm. or less with or without positive biological markers and group III--7 patients with persistently positive biological markers after orchiectomy with normal abdominopelvic computerized tomography scans. In group I 4 of 18 patients received chemotherapy after retroperitoneal lymph node dissection. Two patients met criteria for post-dissection chemotherapy, but they did not receive it and subsequently had relapse. Of the remaining 12 patients who were observed after dissection only 1 (8 per cent) had relapse. In group II 19 of 31 patients were treated with initial chemotherapy: 13 (68 per cent) achieved a complete response, while 6 required retroperitoneal lymph node dissection after chemotherapy. Of 31 patients 12 were treated with initial retroperitoneal lymph node dissection and 9 (75 per cent) received post-dissection chemotherapy. In group III 5 of 7 patients were treated with initial retroperitoneal lymph node dissection and 3 of the 5 subsequently required chemotherapy. Of the 7 patients 2 received initial chemotherapy and achieved a complete response. All 56 patients are without disease at 4+ to 106+ months (median 28 months). We conclude that patients with the characteristics of groups II and III should be managed initially with chemotherapy, with retroperitoneal lymph node dissection reserved for patients who fail to achieve a complete response. In group I retroperitoneal lymph node dissection is sufficient initial treatment if pathological evaluation of the retroperitoneal lymph nodes does not meet our criteria for post-dissection adjuvant chemotherapy.
睾丸非精原细胞瘤合并少量腹膜后转移患者的治疗仍存在争议。我们分析了56例患者的治疗方式，这些患者被分为3组：第一组——18例临床I期癌症患者，在腹膜后淋巴结清扫术后病理分期为II期；第二组——31例患者，腹部盆腔计算机断层扫描异常，直径5厘米及以下，有或无阳性生物学标志物；第三组——7例患者，睾丸切除术后生物学标志物持续阳性，腹部盆腔计算机断层扫描正常。第一组18例患者中有4例在腹膜后淋巴结清扫术后接受了化疗。2例患者符合清扫术后化疗标准，但未接受化疗，随后复发。其余12例清扫术后接受观察的患者中，只有1例（8%）复发。第二组31例患者中，19例接受了初始化疗：13例（68%）获得完全缓解，6例化疗后需要进行腹膜后淋巴结清扫。31例患者中，12例接受了初始腹膜后淋巴结清扫，9例（75%）清扫术后接受了化疗。第三组7例患者中，5例接受了初始腹膜后淋巴结清扫，其中3例随后需要化疗。7例患者中有2例接受了初始化疗并获得完全缓解。所有56例患者在4个月至106个月以上（中位时间28个月）均无疾病。我们得出结论，具有第二组和第三组特征的患者应首先接受化疗，腹膜后淋巴结清扫术仅用于未获得完全缓解的患者。在第一组中，如果腹膜后淋巴结的病理评估不符合我们清扫术后辅助化疗的标准，腹膜后淋巴结清扫术是足够的初始治疗方法。
