Abudurexiti Mierxiati, Zhu Yao, Ye Ding-Wei
Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China.
Mol Clin Oncol. 2020 Aug;13(2):146-154. doi: 10.3892/mco.2020.2057. Epub 2020 Jun 3.
The present study investigated the clinical significance afforded by locoregional surgery in improving the prognosis of primary metastatic testicular cancer (pMTC). The population-based Surveillance, Epidemiology and End Results database was used as the primary source of data in the present study. Stratification analysis was employed to identify the effects of testicular surgery on testicular cancer-specific survival and overall survival. Propensity score matching and Cox regression models were then employed to find and evaluate the extent of improvements to the survival of patients with pMTC by testicular surgery. The median testicular cancer-specific survival and overall survival in the surgery group were 10% higher than those in the group without surgery. Testicular surgery was demonstrated to have provided a survival advantage for patients with a single metastasis in the bone or brain, but not in the liver or lung. When combined with radiotherapy and chemotherapy, surgery significantly improved the survival of patients. However, according to the surgical outcome based on molecular subtypes, when deciding on the surgery for patients with metastatic testicular cancer, only human chorionic gonadotropin and lactate dehydrogenase, and not α-fetoprotein should be considered. Surgery serves a significant role in the management of non-seminoma, whereas its role in the management of seminoma is far more limited. The effects of locoregional surgery have been neglected when treating patients with pMTC. Surgical procedures should be considered more seriously when planning combination treatments for patients with pMTC with a single bone or brain metastasis.
本研究调查了局部区域手术对改善原发性转移性睾丸癌（pMTC）预后的临床意义。基于人群的监测、流行病学和最终结果数据库被用作本研究的主要数据来源。采用分层分析来确定睾丸手术对睾丸癌特异性生存和总生存的影响。然后采用倾向评分匹配和Cox回归模型来寻找和评估睾丸手术对pMTC患者生存改善的程度。手术组的睾丸癌特异性生存和总生存中位数比未手术组高10%。睾丸手术被证明对骨或脑有单一转移的患者有生存优势，但对肝或肺转移的患者则没有。当与放疗和化疗联合使用时，手术显著提高了患者的生存率。然而，根据基于分子亚型的手术结果，在决定对转移性睾丸癌患者进行手术时，应仅考虑人绒毛膜促性腺激素和乳酸脱氢酶，而不考虑甲胎蛋白。手术在非精原细胞瘤的治疗中起着重要作用，而其在精原细胞瘤治疗中的作用则更为有限。在治疗pMTC患者时，局部区域手术的作用一直被忽视。在为有单一骨或脑转移的pMTC患者规划联合治疗时，应更认真地考虑手术程序。
