Xu Peihang, Wang Jun, Abudurexiti Mierxiati, Jin Shengming, Wu Junlong, Shen Yijun, Ye Dingwei
Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Front Oncol. 2020 Jan 10;9:1495. doi: 10.3389/fonc.2019.01495. eCollection 2019.
Existing data on the association of metastatic sites and prognosis of patients with metastatic testicular malignancy are limited. In this study, the association of survival outcome and the prognostic value of different metastatic sites in patients with metastatic testicular cancer was investigated. A dataset from the Surveillance, Epidemiology and End Results (SEER) survey was selected for a retrospective metastatic testicular cancer cohort study. Patients with different metastatic sites were divided into corresponding groups for further analysis. Kaplan-Meier analysis with log-rank test was implemented for comparison of the survival distribution of cases. Multivariate Cox regression models were then applied to analyze the association of distant metastases with survival for all selected patients and subgroup based on different histological type with a single metastatic site. A total of 1,661 patients treated for metastatic testicular malignant tumors between 2010 to 2016 were enrolled in this cohort study. Upon initial diagnosis, 61.9, 15.2, 6.7, 6.4, and 36.2% of patients were found to have lung, liver, bone, brain, and distant lymph nodes metastatic sites, respectively. Patients with lung, liver, or bone metastases showed more undesirable prognosis for overall survival (OS) and cancer-specific survival (CSS), in contrast with those with distant lymph node metastases (all < 0.05). In comparison with patients with more than one metastatic site, those with a single metastasis had extended OS and CSS (both < 0.001). In patients with a single metastatic site, Kaplan-Meier analysis and multivariate Cox regression demonstrated the association of bone and liver with the worst two groups of OS and CSS. Multivariate Cox models based on histological type showed different prognostic values of metastases in patients with seminoma or non-seminomatous germ cell tumors. There is much heterogeneity in the oncological outcome of site-specific metastatic patients. Metastatic profiles and the prognostic value of metastases are dependent on the histological type in TC patients. Distant lymph nodes and lung metastases indicate favorable prognostic factors, while bone and liver metastases indicate negative survival outcomes in TC.
关于转移性睾丸恶性肿瘤患者转移部位与预后之间关联的现有数据有限。在本研究中，对转移性睾丸癌患者的生存结局与不同转移部位的预后价值之间的关联进行了调查。选择了监测、流行病学和最终结果（SEER）调查中的一个数据集用于转移性睾丸癌队列回顾性研究。将具有不同转移部位的患者分为相应组进行进一步分析。采用Kaplan-Meier分析和对数秩检验来比较病例的生存分布。然后应用多变量Cox回归模型分析所有入选患者以及基于不同组织学类型且只有一个转移部位的亚组中远处转移与生存的关联。本队列研究纳入了2010年至2016年间接受转移性睾丸恶性肿瘤治疗的1661例患者。初次诊断时，分别有61.9%、15.2%、6.7%、6.4%和36.2%的患者被发现有肺、肝、骨、脑和远处淋巴结转移部位。与远处淋巴结转移患者相比，有肺、肝或骨转移的患者总生存期（OS）和癌症特异性生存期（CSS）的预后更差（均P<0.05）。与有多个转移部位的患者相比，只有一个转移灶的患者OS和CSS更长（均P<0.001）。在只有一个转移部位的患者中，Kaplan-Meier分析和多变量Cox回归显示骨和肝转移与最差的两组OS和CSS相关。基于组织学类型的多变量Cox模型显示，精原细胞瘤或非精原性生殖细胞肿瘤患者转移的预后价值不同。特定部位转移患者的肿瘤学结局存在很大异质性。转移特征和转移的预后价值取决于睾丸癌患者的组织学类型。远处淋巴结和肺转移提示预后良好因素，而骨和肝转移提示睾丸癌患者生存结局不良。
