Speir Ryan, Cary Clint, Foster Richard S, Masterson Timothy A
Department of Urology, Tripler Army Medical Center, Honolulu, Hawaii.
Department of Urology, Indiana University Medical Center, Indianapolis, Indiana, USA.
Curr Opin Urol. 2018 Sep;28(5):469-473. doi: 10.1097/MOU.0000000000000528.
The purpose of this review is to examine the historical context alongside contemporary studies in order to provide the most current recommendations for the management of patients with metastatic teratoma with malignant somatic transformation (MST).
The main themes in the recent literature covered herein include prognostic features, the management of early-stage disease, recommended chemotherapeutic and surgical strategies as well as recognized patterns of late relapse.
Recent literature, combined with a significant contribution from historical studies, suggests that while MST is uncommon, its aggressive nature coupled with its resistance with traditional germ cell tumor chemotherapies makes it very difficult to manage. The key message is that surgery is recommended in all resectable MST from primary retroperitoneal lymph node dissection for clinical stage I, to radical removal of disease after chemotherapy and when chemotherapy fails. In advanced cases with documented spread of the transformed histologic subtype, systemic therapies targeted to the identified tumor type should be considered.
本综述旨在结合历史背景与当代研究，为转移性畸胎瘤伴恶性体细胞转化（MST）患者的管理提供最新建议。
本文涵盖的近期文献中的主要主题包括预后特征、早期疾病的管理、推荐的化疗和手术策略以及公认的晚期复发模式。
近期文献与历史研究的重大贡献相结合表明，虽然MST并不常见，但其侵袭性以及对传统生殖细胞肿瘤化疗的耐药性使其治疗极具挑战性。关键信息是，对于所有可切除的MST，从临床I期的原发性腹膜后淋巴结清扫术，到化疗后及化疗失败时的疾病根治性切除，均建议进行手术。在已记录转化组织学亚型扩散的晚期病例中，应考虑针对已识别肿瘤类型的全身治疗。
