Dowling Catherine M, Assel Melissa, Musser John E, Meeks Joshua J, Sjoberg Daniel D, Bosl George, Motzer Robert, Bajorin Dean, Feldman Darren, Carver Brett S, Sheinfeld Joel
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, NY.
Urology. 2018 Apr;114:133-138. doi: 10.1016/j.urology.2018.01.014. Epub 2018 Feb 2.
To determine the pathologic findings and clinical outcome of patients with pure embryonal carcinoma (EC) of the testis who were diagnosed with testis cancer from January 1989 to January 2013 who underwent an orchiectomy, cisplatin-based chemotherapy and a postchemotherapy retroperitoneal lymph node dissection (PC-RPLND).
We compared those patients with 100% EC with those with mixed nonseminomatous germ cell tumor pathology who underwent a PC-RPLND.
Of 1105 patients who underwent a PC-RPLND, 145 had pure EC. Twenty-six percent of patients presented with metastatic disease outside the retroperitoneum. Patients with mixed histologies tended to have worse International Germ Cell Cancer Collaborative Group risk compared to those with EC at orchiectomy (P = .037). Histology at PC-RPLND revealed fibrosis or necrosis in 76%, mature teratoma in 19% and viable cancer in 4%. Over one-third of the patients had a residual mass of <1 cm prior to RPLND; of whom 15% harbored mature teratoma in PC-RPLND histology. The Kaplan-Meier estimated probability of recurrence at 5 years of follow-up was 3.1% (95% CI 1.2%, 8.0%) for EC histology, 7.3% lower than mixed histology. For cancer-specific mortality, the Kaplan-Meier estimated probability at 5 years was 4.6% (95% CI 3.3%, 6.3%) and 1.7% (95% CI 0.4%, 6.8%) for mixed and pure EC histologies, respectively.
Approximately 20% of patients with pure EC had teratoma at PC-RPLND. We have shown that those with a maximum node size of <1 cm should not be precluded from RPLND.
确定1989年1月至2013年1月期间被诊断为睾丸癌并接受睾丸切除术、以顺铂为基础的化疗以及化疗后腹膜后淋巴结清扫术（PC-RPLND）的纯胚胎癌（EC）患者的病理结果和临床结局。
我们将那些病理为100%EC的患者与接受PC-RPLND的混合性非精原细胞瘤病理患者进行比较。
在1105例接受PC-RPLND的患者中，145例为纯EC。26%的患者出现腹膜后以外的转移性疾病。与睾丸切除时为EC的患者相比，组织学混合的患者国际生殖细胞癌协作组风险往往更高（P = 0.037）。PC-RPLND时的组织学显示76%为纤维化或坏死，19%为成熟畸胎瘤，4%为存活癌。超过三分之一的患者在RPLND前残留肿块<1 cm；其中15%在PC-RPLND组织学中含有成熟畸胎瘤。EC组织学患者5年随访的Kaplan-Meier复发估计概率为3.1%（95%CI 1.2%，8.0%），比混合组织学低7.3%。对于癌症特异性死亡率，混合和纯EC组织学患者5年的Kaplan-Meier估计概率分别为4.6%（95%CI 3.3%，6.3%）和1.7%（95%CI 0.4%，6.8%）。
约20%的纯EC患者在PC-RPLND时有畸胎瘤。我们已经表明，最大淋巴结大小<1 cm的患者不应被排除在RPLND之外。
