Rejlekova Katarina, Cursano Maria C, De Giorgi Ugo, Mego Michal
2nd Department of Oncology, Faculty of Medicine, National Cancer Institute, Comenius University, Bratislava, Slovakia.
Oncology Unit, Università Campus Bio-Medico, Rome, Italy.
Front Endocrinol (Lausanne). 2019 Apr 12;10:218. doi: 10.3389/fendo.2019.00218. eCollection 2019.
Testicular germ cell tumors (TGCTs) represent the most common solid tumor in young men and is a model of curable cancer. The effectiveness of cisplatin-based chemotherapy secures more than 95% of patients' 5-years survival rate. However, some high-risk patients with a very advanced disease develop choriocarcinoma syndrome (CS) connected with acute respiratory failure with poor prognosis and high mortality rate shortly after beginning systemic chemotherapy. CS was first described as a syndrome with hemorrhage from metastatic sites in patients with TGCTs with significantly high choriogonadotropin level. Acute hemorrhage to lung metastases is typical, but hemorrhage can occur from any metastatic site. Patognomic of choriocarcinoma cells is an invasion of small blood vessels within CS. The incidence of CS in patients with TGCTs are not well-defined and can vary across the world. To date, there are a few case reports and small retrospective series reporting a connection between systemic chemotherapy and the development of CS in metastatic TGCTs. CS is known to be triggered by massive tumor cell lysis as a result of chemotherapy and cytokine release, aggravated with alveolar hemorrhage. This can lead to a consecutive superinfection, furthered with neutropenia after chemotherapy, acute respiratory distress syndrome, rising to systemic inflammatory response, resulting in multiorgan failure and death. A reasonably effective approach in patients with extensive disease could be a shortened course of chemotherapy as well as a reduction of dosage in induction chemotherapy before full-dose chemotherapeutical regimen; however, current data regarding optimal treatment approach are limited. Patients' referral to tertiary centers and the administration of induction chemotherapy in an intensive care unit setting could further improve the treatment outcome.
睾丸生殖细胞肿瘤（TGCTs）是年轻男性中最常见的实体瘤，也是可治愈癌症的一个范例。基于顺铂的化疗有效性确保了超过95%的患者5年生存率。然而，一些疾病非常晚期的高危患者在开始全身化疗后不久会发生与急性呼吸衰竭相关的绒毛膜癌综合征（CS），预后不良且死亡率高。CS最初被描述为TGCTs患者中具有显著高绒毛膜促性腺激素水平且伴有转移部位出血的一种综合征。肺转移灶急性出血很典型，但出血可发生于任何转移部位。绒毛膜癌细胞的特征是在CS内侵袭小血管。TGCTs患者中CS的发病率尚不明确，且在世界各地可能有所不同。迄今为止，仅有少数病例报告和小型回顾性系列报道了转移性TGCTs全身化疗与CS发生之间的关联。已知CS是由化疗导致的大量肿瘤细胞溶解和细胞因子释放引发的，肺泡出血会使其加重。这可导致连续的二重感染，化疗后中性粒细胞减少会进一步加重，引发急性呼吸窘迫综合征，进而发展为全身炎症反应，导致多器官功能衰竭和死亡。对于病情广泛的患者，一种合理有效的方法可能是缩短化疗疗程以及在全剂量化疗方案之前减少诱导化疗的剂量；然而，目前关于最佳治疗方法的数据有限。将患者转诊至三级中心并在重症监护病房环境中进行诱导化疗可能会进一步改善治疗结果。
