Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD, USA; Department of Urology, Johns Hopkins Medicine, Baltimore, MD, USA.
Department of Urology, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.
Eur Urol. 2018 Jun;73(6):899-907. doi: 10.1016/j.eururo.2017.12.030. Epub 2018 Jan 12.
Cancer-specific survival for men with clinical stage I testicular cancer (CSITC) is uniformly excellent. Non-risk-adapted active surveillance (NRAS) is a management strategy for CSITC to minimize overtreatment and avoid possible long-term side effects of adjuvant therapy.
To review the evidence regarding oncologic outcomes for men with CSITC undergoing NRAS and discuss ongoing controversies in the management of CSITC.
MEDLINE/PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from January 1, 1987 through January 1, 2017.
A total of 68 studies were included in the critical review. The rationale for NRAS, oncologic outcomes, surveillance protocols, and comparative efficacy of risk-adjusted active surveillance (AS) were reported with strength of evidence and risk of bias evaluated. Cancer-specific survival approaches 100% for men with CSITC undergoing NRAS. Active treatment is limited to 20-30% of patients who will recur; these patients will require salvage chemotherapy and possible retroperitoneal lymph node dissection. Existing AS protocols include imaging and laboratory evaluations that are initially intensive but less frequent with increasing follow-up.
NRAS is an attractive management option for men with CSITC, which maintains outstanding long-term cancer cure while sparing most patients treatment by avoiding prophylactic chemotherapy, radiation, or surgery.
Men with clinically localized (stage I) testicular cancer have an excellent prognosis, regardless of management. Non-risk-adapted active surveillance is an attractive management option where only patients destined to relapse will receive any treatment following orchiectomy. However, individual patient preferences should be discussed in selecting a management strategy.
患有临床 I 期睾丸癌（CSITC）的男性的癌症特异性存活率普遍极佳。非风险适应性主动监测（NRAS）是 CSITC 的一种管理策略，旨在最大限度地减少过度治疗并避免辅助治疗可能产生的长期副作用。
回顾接受 NRAS 治疗的 CSITC 男性的肿瘤学结果，并讨论 CSITC 管理方面的持续争议。
通过 MEDLINE/PubMed、Embase 和 Cochrane 对照试验中心注册库，从 1987 年 1 月 1 日至 2017 年 1 月 1 日进行了检索。
共有 68 项研究纳入了关键评价。报告了 NRAS 的原理、肿瘤学结果、监测方案以及风险调整后的主动监测（AS）的比较疗效，并评估了证据强度和偏倚风险。接受 NRAS 的 CSITC 男性的癌症特异性存活率接近 100%。仅 20-30%的复发患者需要接受积极治疗；这些患者将需要接受挽救性化疗和可能的腹膜后淋巴结清扫术。现有的 AS 方案包括最初较为密集但随着随访时间增加而频率降低的影像学和实验室评估。
NRAS 是 CSITC 男性的一种有吸引力的治疗选择，既能保持出色的长期癌症治愈率，又能避免预防性化疗、放疗或手术，从而避免大多数患者的治疗。
患有临床局限性（I 期）睾丸癌的男性无论采用何种治疗方法，预后都极佳。非风险适应性主动监测是一种有吸引力的治疗选择，只有那些注定会复发的患者在接受睾丸切除术后续疗。但是，在选择治疗策略时，应讨论患者的个人偏好。
