Rizzo Michele, Ongaro Luca, Claps Francesco, Ghassempour Dario, Verzotti Enrica, Migliozzi Francesca, Boltri Matteo, Pavan Nicola, Garaffa Giulio, Bucci Stefano, Umari Paolo, Trombetta Carlo, Liguori Giovanni
Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy -
Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy.
Minerva Urol Nephrol. 2021 Feb;73(1):84-89. doi: 10.23736/S2724-6051.19.03562-8. Epub 2019 Dec 11.
Abdominopelvic computed tomography (CT) is widely used in the follow-up of seminoma patients after radical orchidectomy. The aim of this study was to evaluate the clinical utility of abdominopelvic computed tomography in the follow-up of patients with Stage I seminoma.
The pathological reports of all patients that have undergone radical orchidectomy in our tertiary referral center between January 2002 and January 2018 have been retrospectively reviewed. All patients with Stage I seminoma and negative serum tumor markers after radical orchidectomy were included. Patients with follow-up shorter than 12 months were excluded. Surveillance records of every patient were reviewed with regard to abdominopelvic imaging.
Of the 133 patients who have undergone radical orchidectomy in our center, 55 had Stage I pure seminoma with normal levels of serum tumor markers after surgery. Two patients were excluded as the follow-up was inadequate. Mean follow-up was 63.2 months (IQR: 30-73). The results of 211 abdominopelvic CTs performed as part of the follow-up were reviewed. Two (3,7%) patients developed recurrence; one consisted of a scrotal lump and was diagnosed with ultrasonography (US) while the second appeared as paraaortic nodal metastasis and was diagnosed with abdominopelvic CT. The recurrence was successfully treated in both patients. A single abdominopelvic CT was useful for the detection of recurrent disease in our entire study population. No cancer specific death has been reported in the study population.
Follow-up schedules for Stage I seminoma expose patients to potential risks of radiation-induced tumors, emotional distress and represent a significant burden for the healthcare system. The current series suggests that a better risk adapted patient-tailored follow-up program is needed in order to avoid unnecessary investigations.
腹盆腔计算机断层扫描（CT）广泛应用于睾丸精原细胞瘤患者根治性睾丸切除术后的随访。本研究旨在评估腹盆腔CT在Ⅰ期精原细胞瘤患者随访中的临床应用价值。
回顾性分析2002年1月至2018年1月在我们三级转诊中心接受根治性睾丸切除术的所有患者的病理报告。纳入所有Ⅰ期精原细胞瘤且根治性睾丸切除术后血清肿瘤标志物阴性的患者。随访时间短于12个月的患者被排除。对每位患者的腹盆腔影像学监测记录进行审查。
在我们中心接受根治性睾丸切除术的133例患者中，55例为Ⅰ期纯精原细胞瘤，术后血清肿瘤标志物水平正常。两名患者因随访不充分被排除。平均随访时间为63.2个月（四分位间距：30 - 73）。对作为随访一部分进行的211次腹盆腔CT结果进行了审查。两名（3.7%）患者出现复发；一名表现为阴囊肿块，通过超声（US）诊断，另一名表现为腹主动脉旁淋巴结转移，通过腹盆腔CT诊断。两名患者的复发均得到成功治疗。在我们的整个研究人群中，单次腹盆腔CT对复发性疾病的检测是有用的。研究人群中未报告癌症特异性死亡。
Ⅰ期精原细胞瘤的随访方案使患者面临辐射诱发肿瘤、情绪困扰的潜在风险，并且对医疗系统构成重大负担。当前系列研究表明，需要一个更好的根据风险调整的个体化患者随访方案，以避免不必要的检查。
