Fosså S D, Aass N, Kaalhus O
Department of Medical Oncology and Radiotherapy, Norwegian Radium, Hospitals, Oslo.
J Surg Oncol. 1988 Sep;39(1):43-63. doi: 10.1002/jso.2930390110.
The clinical experience is reviewed in 597 Norwegian testicular cancer patients (age range: 15-45 years) treated from 1979 to 1986. During this period, computer tomography, determination of serum AFP/HCG, and cisplatin-based chemotherapy represented the modern diagnostic and therapeutic modalities. Before orchiectomy 67% of the patients had elevated AFP/HCG. An abnormal postorchiectomy serum tumour marker decrease and the presence of small vessel infiltration in the histological sections of the primary tumour significantly predicted microscopic retroperitoneal metastases in patients with clinical stage I (CSI) nonseminoma. One-third of these patients had a pathological stage II (PSII). After radiotherapy 99% of 90 seminoma patients (CSI/IIa) survived for 5 years. After cisplatin-based chemotherapy (+radiotherapy/surgery) the 5-year survival rate in 25 patients with advanced seminoma was 81%. The survival rate in 148 nonseminoma patients PSI/IIa was 100% and 87% in 94 patients with advanced nonseminoma (greater than or equal to CSIIb). Nausea, general exhaustion, myelosuppression, peripheral neuropathy, and Raynaud-like phenomena were the main acute treatment-related side effects. Slight gastrointestinal problems, slight peripheral neuropathy, Raynaud-like phenomena, and fertility disturbances were frequent late side effects. The sexual life in testicular cancer patients did not seem to be significantly impaired as compared to the normal population. Most of the patients reported no or only slight emotional problems during and after treatment. The need of thorough information at the time of diagnosis was stressed by most of them. Secondary cancer was diagnosed in 27 of 795 patients (1970-1982) (Testicular: 15; pulmonary: 4; sarcoma: 2; others: 6). Testicular cancer is today a curable malignancy. Future clinical research has to concentrate on the identification of high-risk and low-risk patients, the avoidance of overtreatment, and the reduction of toxicity (especially of long-term side effects).
对1979年至1986年期间接受治疗的597例挪威睾丸癌患者（年龄范围：15 - 45岁）的临床经验进行了回顾。在此期间，计算机断层扫描、血清甲胎蛋白/人绒毛膜促性腺激素测定以及以顺铂为基础的化疗代表了现代诊断和治疗方式。在睾丸切除术之前，67%的患者甲胎蛋白/人绒毛膜促性腺激素升高。睾丸切除术后血清肿瘤标志物异常下降以及原发性肿瘤组织切片中存在小血管浸润显著预测了临床I期（CSI）非精原细胞瘤患者的微观腹膜后转移。这些患者中有三分之一的病理分期为II期（PSII）。90例精原细胞瘤患者（CSI/IIa）放疗后99%存活5年。25例晚期精原细胞瘤患者接受以顺铂为基础的化疗（+放疗/手术）后，5年生存率为81%。148例PSI/IIa期非精原细胞瘤患者的生存率为100%，94例晚期非精原细胞瘤（大于或等于CSIIb）患者的生存率为87%。恶心、全身乏力、骨髓抑制、周围神经病变以及雷诺样现象是主要的急性治疗相关副作用。轻微的胃肠道问题、轻微的周围神经病变、雷诺样现象以及生育功能障碍是常见的晚期副作用。与正常人群相比，睾丸癌患者的性生活似乎未受到明显损害。大多数患者报告在治疗期间及治疗后没有或仅有轻微的情绪问题。他们中的大多数强调在诊断时需要全面的信息。在795例患者（1970 - 1982年）中有27例被诊断为继发性癌症（睾丸：15例；肺部：4例；肉瘤：2例；其他：6例）。如今睾丸癌是一种可治愈的恶性肿瘤。未来的临床研究必须集中于识别高危和低危患者、避免过度治疗以及降低毒性（尤其是长期副作用）。
