Section of Urology, University of Chicago Medicine, Chicago, IL.
Prisma Health-Upstate, Section of Urology, Department of Surgery, University of South Carolina-Greenville.
Urol Oncol. 2020 Aug;38(8):687.e13-687.e18. doi: 10.1016/j.urolonc.2020.03.014. Epub 2020 Apr 15.
For marker-negative clinical stage (CS) IIA nonseminomatous germ cell tumor (NSGCT), National Comprehensive Cancer Network and American Urological Association guidelines recommend either retroperitoneal lymph node dissection (RPLND) or induction chemotherapy. The goal is cure with one form of therapy. We evaluated national practice patterns in the management of CSIIA NSGCT and utilization of secondary therapies.
The National Cancer Data Base was used to identify 400 men diagnosed with marker negative CSIIA NSGCT between 2004 and 2014 treated with RPLND or chemotherapy. Trends in the utilization of initial and adjuvant treatment (chemotherapy only, RPLND only, RPLND with adjuvant chemotherapy, and postchemotherapy RPLND) were analyzed.
Of the 400 cases, 233 (58%) underwent induction chemotherapy with surveillance, 51 (20%) underwent RPLND with surveillance, 89 (22%) underwent RPLND followed by adjuvant chemotherapy, and 14 (4%) underwent induction chemotherapy followed by RPLND. Thirty percent of patients received dual therapy. After RPLND with pN1 staging, 43 (61%) underwent adjuvant chemotherapy. The pN0 rate after primary RPLND was 22%. Five year overall survival ranged from 95% to 100% based on initial treatment choice.
For marker negative CS IIA nonseminoma, dual, therapy, and treatment with chemotherapy is common. With low volume retroperitoneal disease resected at RPLND, adjuvant chemotherapy was frequently administered but has debatable therapeutic value. These data highlight opportunities to decrease treatment burden in patients with CS IIA nonseminoma.
对于 marker 阴性的临床分期（CS）IIA 非精原细胞瘤生殖细胞肿瘤（NSGCT），国家综合癌症网络和美国泌尿外科学会指南建议进行腹膜后淋巴结清扫术（RPLND）或诱导化疗。目标是通过一种治疗方法治愈。我们评估了 CSIIA NSGCT 的管理和辅助治疗的国家实践模式以及辅助治疗的应用。
国家癌症数据库用于确定 2004 年至 2014 年间诊断为 marker 阴性 CSIIA NSGCT 的 400 名男性，他们接受了 RPLND 或化疗治疗。分析了初始和辅助治疗（仅化疗、仅 RPLND、RPLND 联合辅助化疗和化疗后 RPLND）的应用趋势。
在 400 例病例中，233 例（58%）接受了诱导化疗和监测，51 例（20%）接受了 RPLND 和监测，89 例（22%）接受了 RPLND 后辅助化疗，14 例（4%）接受了诱导化疗后 RPLND。30%的患者接受了双重治疗。RPLND 后 pN1 分期后，43 例（61%）接受了辅助化疗。原发 RPLND 的 pN0 率为 22%。根据初始治疗选择，5 年总生存率从 95%到 100%不等。
对于 marker 阴性的 CS IIA 非精原细胞瘤，联合、化疗和治疗是常见的。在 RPLND 切除的腹膜后疾病体积较小的情况下，常给予辅助化疗，但治疗价值存在争议。这些数据突出了在 CS IIA 非精原细胞瘤患者中减少治疗负担的机会。
