USC Institute of Urology/Norris Comprehensive Cancer Center, Los Angeles, California, USA.
Curr Opin Urol. 2019 Jan;29(1):33-41. doi: 10.1097/MOU.0000000000000563.
Management of extraretroperitoneal (ERP) germ cell tumor (GCT) is a complex clinical scenario faced by urologic oncologists. This article reviews the indications and approach to management of ERP GCT masses.
ERP GCT management starts with chemotherapy, and for any residual masses, a careful consideration of surgical intervention versus salvage chemotherapy. Decision-making regarding residual ERP masses hinges on tumor markers, and also the anatomical location. These factors should be contextualized by the patient's risk for teratoma or active GCT, which will impact outcome and thus weigh on decision-making conversations with patients who have advanced disease. Technical challenges of surgical management in the postchemotherapy setting also apply in ERP mass resection. The risks of surgical management in the lung and liver, in particular, add special considerations for morbidity. Surgical resection is often the only recourse for a patient who may have chemoresistant disease and may be an important step in achieving cure.
Surgical management of ERP GCT requires multidisciplinary input, and the urologic oncologist can help guide management with particular emphasis on the indication, timing, and approach to surgical resection.
腹膜后（ERP）生殖细胞肿瘤（GCT）的治疗是泌尿科肿瘤医生面临的复杂临床情况。本文回顾了 ERP GCT 肿块的治疗指征和方法。
ERP GCT 的治疗始于化疗，对于任何残留肿块，需要仔细考虑手术干预与挽救性化疗。残留 ERP 肿块的处理取决于肿瘤标志物，也取决于解剖位置。这些因素应根据患者发生畸胎瘤或活性 GCT 的风险来进行评估，这将影响结果，并影响与患有晚期疾病的患者进行的决策讨论。化疗后手术管理的技术挑战也适用于 ERP 肿块切除术。肺和肝的手术管理风险特别增加了发病率的特殊考虑因素。手术切除通常是对可能患有耐药性疾病的患者的唯一选择，并且可能是实现治愈的重要步骤。
ERP GCT 的手术治疗需要多学科的投入，泌尿科肿瘤医生可以帮助指导治疗，特别强调手术切除的适应证、时机和方法。
