GKT School of Medical Education, King's College London, London, UK.
College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
BJU Int. 2018 Aug;122(2):236-242. doi: 10.1111/bju.14214. Epub 2018 Apr 17.
To determine the frequency of spermatogenesis in patients with testicular cancer and to assess for any predictors of spermatogenesis.
We retrospectively reviewed 103 testicular germ cell tumours (TGCTs) in men who underwent radical orchidectomy conducted at Guy's Hospital, London, between 2011 and 2015. Primary outcome measures included: the presence and characteristics of spermatogenesis (widespread/focal/proximity to tumour). Secondary outcome measures included: the presence of testicular microlithiasis, tumour characteristics (size, stage, and type), and tumour markers. Secondary outcome measures as potential predictors of spermatogenesis were assessed using univariate and multivariate logistic regression analyses.
Spermatogenesis was present in 70% (72/103) of the patients; it was widespread in 63% (45/72) and focal in 38% (27/72). Neither tumour type, stage, presence of microcalcification nor tumour markers predicted spermatogenesis. Men with a percentage testis tumour occupation (PTTO) of >50% of their testis were 82% (95% confidence interval 73.2-98.4) less likely to have spermatogenesis than a PTTO of <50%.
Spermatogenesis is present in most testes affected by TGCTs; it is widespread in two-thirds of patients, and located away from the tumour in 94%. These findings can help predict and guide successful surgical sperm retrieval in testes with TGCTs. The finding of focal spermatogenesis in a third of patients would support a microsurgical approach to sperm retrieval at the time of orchidectomy to maximise success.
确定睾丸生殖细胞肿瘤（TGCT）患者的生精频率，并评估生精的任何预测因素。
我们回顾性分析了 2011 年至 2015 年期间在伦敦盖伊医院接受根治性睾丸切除术的 103 例男性 TGCT 患者。主要结局指标包括：生精的存在和特征（广泛/局灶/靠近肿瘤）。次要结局指标包括：睾丸微石症、肿瘤特征（大小、分期和类型）和肿瘤标志物。使用单变量和多变量逻辑回归分析评估了作为生精潜在预测因素的次要结局指标。
70%（72/103）的患者存在生精；63%（45/72）为广泛型，38%（27/72）为局灶型。肿瘤类型、分期、微钙化的存在或肿瘤标志物均不能预测生精。睾丸肿瘤占位百分比（PTTO）>50%的男性生精的可能性比 PTTO<50%的男性低 82%（95%置信区间 73.2-98.4）。
大多数患有 TGCT 的睾丸都存在生精；三分之二的患者为生精广泛型，且 94%的生精远离肿瘤。这些发现可以帮助预测和指导 TGCT 睾丸中成功的手术精子获取。三分之一患者存在局灶性生精，这支持在睾丸切除术时采用微创手术方法以最大限度提高成功率。
