Department of Urology, Klinik Favoriten, Vienna, AUSTRIA.
Department of Urology, Klinik Favoriten, Vienna, AUSTRIA; Sigmund Freud Private University, Vienna, AUSTRIA.
Urology. 2021 Aug;154:196-200. doi: 10.1016/j.urology.2021.04.003. Epub 2021 Apr 18.
To report our findings in patients with determination of testicular tumor markers from the vena spermatica during inguinal orchiectomy.
In a retrospective setting, data of patients who underwent inguinal orchiectomy between January 2004 and December 2014 were analyzed. Cubital and testicular vein tumor markers were assessed and correlated to histology, clinical stage and outcome.
A total of 90 patients (seminomatous: n = 53, non-seminomatous: n = 37) with a median age of 37 years were included. The mean follow-up was 109 months. Overall, 60% (n = 54) of patients had one or more positive tumor marker level in the cubital vein vs 88.9% (n = 80) in the testicular vein. Median tumor marker levels of hCGβ in cubital and testicular vein were 1.9 U/l and 30.8U/l; the respective values for AFP were 2.9ng/ml and 2.4ng/ml and for hPLAP 49.9 mU/l and 418.9 mU/l. Differences in cubital vs testicular vein positivity were stage dependant and highest for pT1. Patients with seminomatous tumors had peripheral positivity of 59.3% vs 88.9% in the testicular vein (P = 0.003); in non-seminomatous patients the respective values were 61.1% and 88.9% (P = 0.02). All recurrent cancer patients under active surveillance (n = 5) were positive in the testicular vein.
Virtually all testicular cancers shed tumor markers in the circulation. Differences in marker positivity (testicular vs testicular vein) were stage dependent (greatest in pT1), largely independent of histology and highest for hCGβ. The prognostic value of testicular vein sampling remains speculative.
报告我们在腹股沟睾丸切除术时从精索静脉中检测睾丸肿瘤标志物的患者发现。
在回顾性研究中，分析了 2004 年 1 月至 2014 年 12 月间接受腹股沟睾丸切除术的患者的数据。评估了肘静脉和睾丸静脉的肿瘤标志物，并与组织学、临床分期和结果相关联。
共纳入 90 例患者（精原细胞瘤：n=53，非精原细胞瘤：n=37），中位年龄为 37 岁。平均随访时间为 109 个月。总体而言，60%（n=54）的患者在肘静脉中有一个或多个肿瘤标志物水平阳性，而 88.9%（n=80）的患者在睾丸静脉中有一个或多个肿瘤标志物水平阳性。肘静脉和睾丸静脉 hCGβ 的中位肿瘤标志物水平分别为 1.9 U/l 和 30.8 U/l；AFP 的相应值分别为 2.9ng/ml 和 2.4ng/ml，hPLAP 分别为 49.9 mU/l 和 418.9 mU/l。肘静脉与睾丸静脉阳性之间的差异与分期有关，在 pT1 期最为明显。精原细胞瘤患者的外周阳性率为 59.3%，睾丸静脉阳性率为 88.9%（P=0.003）；非精原细胞瘤患者的相应值分别为 61.1%和 88.9%（P=0.02）。所有接受主动监测的复发性癌症患者（n=5）在睾丸静脉中均为阳性。
几乎所有睾丸癌在循环中都会释放肿瘤标志物。标记物阳性（睾丸与睾丸静脉）之间的差异与分期有关（pT1 期最为明显），与组织学关系不大，hCGβ 的差异最大。睾丸静脉取样的预后价值仍不确定。
