探讨 I 期睾丸精原细胞瘤根治性睾丸切除术的晚期效应谱：文献系统评价。
Exploring the spectrum of late effects following radical orchidectomy for stage I testicular seminoma: a systematic review of the literature.
机构信息
Eastern Health Cancer Services, Level 4, 8 Arnold St., Box Hill, VIC, 3128, Australia.
Eastern Health Library Services, 5 Arnold St., Box Hill, VIC, 3128, Australia.
出版信息
Support Care Cancer. 2019 Feb;27(2):373-382. doi: 10.1007/s00520-018-4492-7. Epub 2018 Oct 22.
PURPOSE
Testicular seminomas occur in young men and are highly curable. Toxicities following treatment for men with extensive stage II-III seminomas may cause long-term morbidities. However, it is not clear whether the risk of late effects also increases following surgery for testis-confined seminoma. In this systematic review, we examined the available literature regarding the incidence of late effects in our target population of patients with stage I seminoma treated with orchidectomy alone.
METHOD
Publications were identified through an electronic literature search using the MEDLINE, EMBASE and PsychInfo databases, identifying cohorts treated for stage I seminoma. Data on late effects were collected and classified as physical or psychological.
RESULTS
Six hundred and four articles were screened to identify 100 studies. In the target population, available evidence suggests no increased risk of cardiovascular disease, metabolic syndrome, or renal dysfunction compared to the general population. Sperm counts were initially lower than an age-matched cohort; however, counts normalised when re-assessed 5 years later. Data were not specifically reported for the target population regarding bone health, second malignancy, hypogonadism, fertility and all psychological domains. Heterogeneity of study design and reporting methods contributed to uncertainty regarding the true incidence and clinical significance of late effects.
CONCLUSIONS
The curability of stage I seminoma and the wide range of potential late effects of treatment suggest the need for long-term monitoring alongside standard cancer surveillance. Important data are needed on the prevalence of late effects, specifically related to testicular cancer survivors undergoing surveillance following orchidectomy.
IMPLICATIONS FOR CANCER SURVIVORS
Awareness and screening for relevant late effects may prevent further morbidity in men treated for stage I seminoma.
目的
睾丸精原细胞瘤发生于年轻人，具有高度可治愈性。广泛 II-III 期精原细胞瘤患者接受治疗后的毒性可能导致长期发病。然而，对于局限于睾丸的精原细胞瘤患者，手术治疗后是否也会增加晚期效应的风险尚不清楚。在这项系统评价中，我们检查了关于我们的局限于睾丸的 I 期精原细胞瘤患者单纯睾丸切除术治疗的目标人群中晚期效应发生率的现有文献。
方法
通过使用 MEDLINE、EMBASE 和 PsychInfo 数据库进行电子文献检索，确定了治疗 I 期精原细胞瘤的队列研究。收集了晚期效应的数据，并分为身体或心理方面。
结果
筛选了 604 篇文章以确定 100 项研究。在目标人群中，与一般人群相比，心血管疾病、代谢综合征或肾功能障碍的风险没有增加。与年龄匹配的队列相比，精子计数最初较低；然而，5 年后再次评估时计数正常化。关于目标人群的骨健康、第二恶性肿瘤、性腺功能减退、生育能力和所有心理领域的数据没有专门报告。研究设计和报告方法的异质性导致了对晚期效应真实发生率和临床意义的不确定性。
结论
I 期精原细胞瘤的可治愈性和治疗的广泛潜在晚期效应表明需要进行长期监测，同时进行标准的癌症监测。需要关于晚期效应的流行率的重要数据，特别是与接受睾丸切除术进行监测的睾丸癌幸存者相关的数据。
对癌症幸存者的影响
对相关晚期效应的认识和筛查可能预防接受 I 期精原细胞瘤治疗的男性的进一步发病。
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