Niemczyk Grzegorz, Zapała Łukasz, Borkowski Tomasz, Szabłoński Waldemar, Radziszewski Piotr, Cudnoch-Jędrzejewska Agnieszka
Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland.
Department of Urology, Medical University of Warsaw, Warsaw, Poland.
Cent European J Urol. 2021;74(1):10-13. doi: 10.5173/ceju.2021.0268. Epub 2021 Feb 4.
Widespread use of scrotal ultrasonography has led to the detection of incidental, non-palpable small testicular masses (STMs). Historically, all intratesticular masses were treated radically, however more conservative strategies are now being applied with growing evidence that up to 80% of STMs are benign lesions. Testis-sparing surgery is deemed a gold standard in STMs. However, the high probability of the benign nature of STMs and the excellent cure rate of localized testicular cancer has led to emerging attempts to use an active surveillance (AS) strategy for selected groups of patients.
We conducted a non-systematic review of the literature in the PubMed and Embase databases for articles associated with AS strategy in STMs.
The main inclusion criteria for AS in patients with STMs were lack of risk factors of testicular cancer, no features of disseminated disease, negative tumor markers, non-palpable lesion that did not exceed 10 mm. Mean follow-up time of AS across the studies ranged from 9.6 to 29.6 months. Surveillance protocols were based on regular physical examination, scrotal ultrasonography and measurement of tumor markers. The change rate to active treatment ranged from 0% to 8% without reported deterioration of oncological outcomes. Patients have proceeded to surgical treatment based on their preference, lesion growth, change in echogenicity, tumor marker growth and the need for testicular exploration for other reasons.
Active surveillance is a reasonable conservative strategy in the management of STMs in selected groups of patients with minimal risk of deteriorating impact on oncological outcomes.
阴囊超声检查的广泛应用使得偶然发现的、触诊不到的小睾丸肿块（STM）得以被检测出来。从历史上看，所有睾丸内肿块都采用根治性治疗，然而，现在越来越多地采用更为保守的策略，因为越来越多的证据表明，高达80%的STM是良性病变。保留睾丸手术被认为是STM的金标准。然而，STM具有较高的良性可能性以及局限性睾丸癌的高治愈率，这促使人们尝试对特定患者群体采用主动监测（AS）策略。
我们在PubMed和Embase数据库中对与STM的AS策略相关的文章进行了非系统性文献综述。
STM患者AS的主要纳入标准为缺乏睾丸癌风险因素、无播散性疾病特征、肿瘤标志物阴性、触诊不到且不超过10毫米的病变。各项研究中AS的平均随访时间为9.6至29.6个月。监测方案基于定期体格检查、阴囊超声检查和肿瘤标志物测量。主动治疗的变化率为0%至8%，且未报告肿瘤学结局恶化。患者根据自身偏好、病变生长、回声性变化、肿瘤标志物升高以及因其他原因需要进行睾丸探查而接受手术治疗。
对于对肿瘤学结局恶化影响风险最小的特定患者群体，主动监测是一种合理的保守策略，用于管理STM。
