Nason Gregory J, Jewett Michael A S, Bostrom Peter J, Goldberg Hanan, Hansen Aaron R, Bedard Philippe L, Sturgeon Jeremy, Warde Padraig, Chung Peter, Anson-Cartwright Lynn, Sweet Joan, Atenafu Eshetu G, O'Malley Martin, Hamilton Robert J
Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada.
Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
Eur Urol Oncol. 2021 Apr;4(2):289-296. doi: 10.1016/j.euo.2020.08.007. Epub 2020 Sep 6.
There is controversy regarding the management of patients with normal markers and residual masses (≤1 cm) after chemotherapy for nonseminomatous germ cell tumors (NSGCTs).
To determine long-term outcomes of a surveillance strategy in such patients.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of our multidisciplinary testicular cancer database was performed. All patients who underwent primary chemotherapy for metastatic NSGCTs were identified between 1981 and 2016. A complete response (CR) was defined as normalization of serum tumor markers and a ≤1 cm residual mass in the largest axial dimension following chemotherapy. All such patients were surveilled.
Outcome variables of interest were time to death, time to cancer-specific survival, and time to relapse. Overall survival and relapse-free survival were calculated using the Kaplan-Meier method, and the cumulative incidence of cause-specific survival rates was calculated using competing risk analysis. The impact of risk group and chemotherapy regimen on relapse-free survival was assessed using log-rank test.
During the study period, 1429 metastatic germ cell tumor patients were treated with primary chemotherapy. CR was achieved in 191 (18.5%) NSGCT patients. The median age at diagnosis was 27.4 yr, with a median follow-up of 81.1 mo. The majority had American Joint Committee on Cancer stage II at diagnosis (I: 23.8%; II: 49.2%; III: 27%) and International Germ Cell Cancer Collaborative Group good-risk disease (good: 78%; intermediate: 17.8%; poor: 4.2%). Of the 191 patients with a CR, 175 (91.6%) never relapsed and remain disease free. Sixteen (8.4%) patients relapsed after a median of 11.3 mo (range 1-332 mo), with over half (nine patients; 4.7%) relapsing in the retroperitoneum only and salvaged successfully with postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) alone. Of these nine patients, only two (1%) had viable disease in the PC-RPLND specimen. The remaining seven patients had relapses outside the retroperitoneum and received salvage chemotherapy ± postchemotherapy resection. Overall, nine (4.7%) patients have died, but only four (2.1%) from testis cancer.
Our data, the largest series to date, confirm that surveillance is safe and effective for men who achieve a CR following chemotherapy for metastatic NSGCTs.
Surveillance is a safe strategy for patients who achieve a complete response following chemotherapy for metastatic testis cancer.
对于非精原细胞瘤性生殖细胞肿瘤（NSGCTs）化疗后标志物正常且残留肿块（≤1 cm）患者的管理存在争议。
确定此类患者监测策略的长期结果。
设计、设置和参与者：对我们多学科睾丸癌数据库进行回顾性分析。确定1981年至2016年间所有接受转移性NSGCTs一线化疗的患者。完全缓解（CR）定义为化疗后血清肿瘤标志物正常且最大轴向尺寸残留肿块≤1 cm。所有此类患者均接受监测。
感兴趣的结果变量为死亡时间、癌症特异性生存时间和复发时间。采用Kaplan-Meier法计算总生存率和无复发生存率，采用竞争风险分析计算病因特异性生存率的累积发生率。采用对数秩检验评估风险组和化疗方案对无复发生存率的影响。
在研究期间，1429例转移性生殖细胞肿瘤患者接受了一线化疗。191例（18.5%）NSGCT患者达到CR。诊断时的中位年龄为27.4岁，中位随访时间为81.1个月。大多数患者诊断时为美国癌症联合委员会II期（I期：23.8%；II期：49.2%；III期：27%），国际生殖细胞癌协作组低风险疾病（低风险：78%；中风险：17.8%；高风险：4.2%）。在191例达到CR的患者中，175例（91.6%）从未复发，仍无疾病。16例（8.4%）患者在中位11.3个月（范围1 - 332个月）后复发，其中超过一半（9例患者；4.7%）仅在腹膜后复发，仅通过化疗后腹膜后淋巴结清扫术（PC - RPLND）成功挽救。在这9例患者中，PC - RPLND标本中仅2例（1%）有存活病灶。其余7例患者在腹膜后以外复发，接受挽救性化疗±化疗后切除术。总体而言，9例（4.7%）患者死亡，但仅4例（2.1%）死于睾丸癌。
我们的数据是迄今为止最大的系列研究，证实对于转移性NSGCTs化疗后达到CR的男性，监测是安全有效的。
对于转移性睾丸癌化疗后达到完全缓解的患者，监测是一种安全的策略。
