Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
Urol Oncol. 2020 May;38(5):344-353. doi: 10.1016/j.urolonc.2020.02.023. Epub 2020 Mar 17.
Radical inguinal orchiectomy is the standard of care for men diagnosed with a testicular mass suspicious for germ cell tumor (TGCT). Nontraditional approaches to management, including testis-sparing surgery (TSS) and scrotal orchiectomy, occur in clinical practice. We systematically reviewed studies evaluating outcomes after TSS and scrotal violation for the management of a suspected TGCT. We used PubMed, Embase, and the Cochrane Central Register of Controlled Trials (January 1980-December 2018) to search for studies addressing morbidity and oncologic outcomes after TSS or scrotal violation for testicular masses concerning for TGCT. Paired reviewers independently screened abstracts for inclusion, sequentially extracted data, and assessed study quality. Twenty-one studies were included (10 TSS, 11 scrotal violation). Risk of local recurrence after TSS on meta-analysis was 7.5% after 3 to 5 years (absolute proportion reported in studies: 10.9%). Aggregated rates of positive margins (1.4%) and testicular atrophy (2.8%) across studies were low with 7.1% of patients requiring subsequent androgen therapy. Scrotal violation led to a higher aggregate risk of local recurrence compared to no scrotal violation (2.5% vs. 0.0%, P < 0.001) but did not appear to impact subsequent metastasis and survival in the short term (3-5 years). Most patients received adjuvant therapy after scrotal violation with 9.3% found to harbor residual primary tumor after scrotal scar excision. TSS carries a quantifiable risk of local recurrence after 3 to 5 years despite the majority receiving adjuvant radiation or chemotherapy. Scrotal violation carries a risk of local recurrence but does not appear to impact subsequent metastasis and survival in the short term.
根治性腹股沟睾丸切除术是诊断为睾丸肿块疑似生殖细胞瘤（TGCT）的男性的标准治疗方法。非传统的管理方法，包括保留睾丸手术（TSS）和阴囊睾丸切除术，在临床实践中也有应用。我们系统地回顾了评估 TSS 和阴囊侵犯用于管理疑似 TGCT 后结局的研究。我们使用 PubMed、Embase 和 Cochrane 中央对照试验注册库（1980 年 1 月至 2018 年 12 月）搜索了关于 TSS 或阴囊侵犯用于治疗睾丸肿块疑似 TGCT 的发病率和肿瘤学结局的研究。配对审查员独立筛选摘要纳入，顺序提取数据，并评估研究质量。共纳入 21 项研究（10 项 TSS，11 项阴囊侵犯）。TSS 后 3 至 5 年局部复发的荟萃分析风险为 7.5%（研究报告的绝对比例为 10.9%）。多项研究中阳性切缘（1.4%）和睾丸萎缩（2.8%）的汇总率较低，有 7.1%的患者需要随后进行雄激素治疗。与无阴囊侵犯相比，阴囊侵犯导致的局部复发总风险更高（2.5%比 0.0%，P<0.001），但在短期（3-5 年）内似乎不会影响随后的转移和生存。大多数患者在阴囊侵犯后接受辅助治疗，其中 9.3%在阴囊瘢痕切除后发现仍有原发性肿瘤残留。尽管大多数患者接受了辅助放疗或化疗，但 TSS 在 3 至 5 年后仍存在局部复发的风险。阴囊侵犯存在局部复发的风险，但在短期内似乎不会影响随后的转移和生存。
