Selvi Ismail, Sarikaya Selcuk, Başar Halil
Department of Urology. Karabük University Training and Research Hospital. Karabük. Turkey.
Department of Urology. Health Science University Gulhane Training and Research Hospital. Ankara. Turkey.
Arch Esp Urol. 2020 Apr;73(3):215-229.
Although it is a well known condition that presence of testicular microlithiasis (TM) with the co-occurrence of specific risk factors such as historyof previous germ cell testicular cancer (GCTC), infertility, undescended testes or atrophic testes have high risks for GCTC development, TM is still a controversial topic. Its effects on oncological outcomes have still not been investigated in detail. In this study, we aimed to evaluate whether the presence of TM has an effect on GCTC prognosis and oncological outcomes.
Seventy five patients among 93 patients who underwent radical orchidectomy between January 2010 and February 2016 were selected and divided into two groups. Group I consisted of 51 patients without TM. Group II consisted of 24 patients with TM. Each groups were compared in terms of demographic datas, prognostic risk factors, complete blood count parameters and oncological outcomes.
During the median follow-up of 58 (1-106) months, a significantly higher local recurrence rate (54.2% vs. 3.9%, p<0.001) distant metastasis rate (58.3% vs. 5.9%, p<0.001) and lower cancer-specific survival rate (45.8% vs. 94.1%, p<0.001) were observed in patients with TM. In this group, the duration of recurrence-free survival (47.65±9.45 vs.101.96±2.80 months, p<0.001), metstais-free survival (49.50±8.88 vs. 100.00±3.36 months, p<0.001) and cancer-specific survival (54.37±8.76 vs. 100.19±3.25 months, p<0.001) were also statisticaly lower. In multivariate analysis, β-hCG, LDH, neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio and the presence of undescended testis were found as independent predictive factors for local recurrence, distant metastasis and cancer-specific survival. Red blood cell distribution width and the presence of testicular microlithiasis were found to be independent predictive factors for local recurrence.
According to our results, bilateral TM was associated with higher rates of local recurrence, distant metastasis and cancer spesific mortality in presenceof risk factors, regardless of classic or limited microlithiasis.
虽然众所周知，睾丸微结石症（TM）与特定风险因素（如既往生殖细胞睾丸癌（GCTC）病史、不育、隐睾或萎缩睾丸）同时存在时，发生GCTC的风险很高，但TM仍是一个有争议的话题。其对肿瘤学结局的影响仍未得到详细研究。在本研究中，我们旨在评估TM的存在是否对GCTC预后和肿瘤学结局有影响。
选取2010年1月至2016年2月期间接受根治性睾丸切除术的93例患者中的75例，并将其分为两组。第一组由51例无TM的患者组成。第二组由24例有TM的患者组成。比较两组患者的人口统计学数据、预后风险因素、全血细胞计数参数和肿瘤学结局。
在中位随访58（1 - 106）个月期间，TM患者的局部复发率（54.2%对3.9%，p<0.001）、远处转移率（58.3%对5.9%，p<0.001）显著更高，癌症特异性生存率（45.8%对94.1%，p<0.001）更低。在该组中，无复发生存期（47.65±9.45对101.96±2.80个月，p<0.001）、无转移生存期（49.50±8.88对100.00±3.36个月，p<0.001）和癌症特异性生存期（54.37±8.76对100.19±3.25个月，p<0.001）在统计学上也更低。在多变量分析中，β - hCG、乳酸脱氢酶、中性粒细胞/淋巴细胞比值、单核细胞/淋巴细胞比值和隐睾的存在被发现是局部复发、远处转移和癌症特异性生存的独立预测因素。红细胞分布宽度和睾丸微结石症的存在被发现是局部复发的独立预测因素。
根据我们的结果，在存在风险因素的情况下，双侧TM与更高的局部复发率、远处转移率和癌症特异性死亡率相关，无论微结石症是典型的还是局限性的。
