Medical Oncology Department, Virgen del Rocío University Hospital, Seville, Spain.
Urology Department, Virgen del Rocío University Hospital, Seville, Spain.
Clin Transl Oncol. 2019 Jun;21(6):796-804. doi: 10.1007/s12094-018-1990-5. Epub 2018 Nov 23.
Cancer-specific survival for patients with clinical stage I (CSI) germ cell testicular cancer (GCTC) is outstanding after inguinal orchidectomy regardless the treatment utilized. This study evaluated whether active surveillance (AS) of such patients yielded similar health outcomes to other therapeutic strategies such as adjuvant chemotherapy, radiotherapy or primary retroperitoneal lymphadenectomy as described in the literature.
Patients with CSI GCTC were screened between January 2012 and December 2016. Patients had previously undergone inguinal orchidectomy as the primary treatment and chosen AS as their preferred management strategy after receiving information about all available strategies.
Out of 91 patients screened, 82 patients selected AS as their preferred management strategy. Relapse rate in the overall population was 20% (95% CI 12-30) and median time to relapse was 11.5 months (range 1.0-35.0). In patients with seminomatous tumors, relapse rate decreased to 13% and median time to relapse was 13 months; whereas in patients with non-seminomatous tumors, relapse rate was 33% (IA) or 29% (IB) and median time to relapse was 12 months in stage IA and 4.5 months in stage IB patients. All relapses were rescued with three or four cycles of chemotherapy and two also required a retroperitoneal lymphadenectomy. All patients are currently alive and free of disease.
The clinical outcomes of patients with CSI GCTC managed by AS in this series were excellent. This strategy limited the administration of active treatments specifically to the minority of patients who relapsed without compromising performance.
接受腹股沟睾丸切除术治疗的临床 I 期（CSI）生殖细胞瘤睾丸癌（GCTC）患者的癌症特异性生存时间极佳，无论采用何种治疗方法。本研究评估了对 CSI-GCTC 患者采用主动监测（AS）策略是否可获得与其他治疗策略（如文献中描述的辅助化疗、放疗或原发性腹膜后淋巴结清扫术）相似的健康结果。
2012 年 1 月至 2016 年 12 月期间筛选 CSI-GCTC 患者。这些患者此前接受了腹股沟睾丸切除术作为初始治疗，在了解了所有可用治疗策略后，选择 AS 作为首选治疗策略。
在筛查的 91 例患者中，82 例患者选择 AS 作为首选管理策略。总体人群的复发率为 20%（95%CI 12-30），中位复发时间为 11.5 个月（范围 1.0-35.0）。在精原细胞瘤患者中，复发率降至 13%，中位复发时间为 13 个月；而非精原细胞瘤患者的复发率分别为 IA 期 33%和 IB 期 29%，IA 期患者的中位复发时间为 12 个月，IB 期患者的中位复发时间为 4.5 个月。所有复发患者均通过 3 或 4 个周期的化疗和 2 次腹膜后淋巴结清扫术得到挽救。所有患者均存活且无疾病。
本研究中 CSI-GCTC 患者接受 AS 管理的临床结局极佳。该策略可将积极治疗的应用仅限于复发的少数患者，而不会影响其生存。
