Jia Shi, Qiu Jingping
7th General Surgery Unit, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Radiation Oncology, the First Hospital of China Medical University, Shenyang, China.
Transl Cancer Res. 2021 Jan;10(1):417-423. doi: 10.21037/tcr-20-2545.
Radiotherapy has long been considered the standard adjuvant treatment after radical orchidectomy for stage I seminoma. However, active surveillance and carboplatin chemotherapy have recently become alternative strategies. Despite this, the transition in management regimens is not yet fully recognized. Thus, this study aimed to analyze the 40-year trend in radiotherapy for patients with stage I seminoma in the United States.
We identified 21,976 men in the Surveillance, Epidemiology, and End Results (SEER) database who were registered in 18 centers and who had a diagnosis of localized testis seminoma between 1975 and 2015. Patients of unknown age or whose tumors were not malignant were excluded. We investigated the rate of radiotherapy, chemotherapy and surveillance by year of diagnosis, clarified the characteristics related to the decline in radiotherapy rate, and analyzed patient survival by year of diagnosis.
From 1975 to 2015, 52.9% (11,622/21,976) patients with stage I seminoma received external radiotherapy. The rate of radiotherapy, however, gradually decreased to 46.7% (189/405) in 2008, 18.6% (70/376) in 2012, and 5.3% (19/359) in 2015. Patients aged under 34 years and married patients were more likely to avoid radiotherapy in the 21 century. Compared with the 1975-1999 time period, patient overall survival (OS) decreased significantly in 2000-2007. However, OS during 2008-2015 was not statistically different than that during the 1975-1999 time period.
The role of radiotherapy in patients with stage I seminoma has fundamentally changed in the past 40 years and is no longer an essential treatment in the real-world management of this patient group.
长期以来，放射治疗一直被视为I期精原细胞瘤根治性睾丸切除术后的标准辅助治疗方法。然而，主动监测和卡铂化疗最近已成为替代策略。尽管如此，管理方案的转变尚未得到充分认识。因此，本研究旨在分析美国I期精原细胞瘤患者放射治疗的40年趋势。
我们在监测、流行病学和最终结果（SEER）数据库中识别出21976名男性，他们在18个中心登记，于1975年至2015年间被诊断为局限性睾丸精原细胞瘤。年龄未知或肿瘤为非恶性肿瘤的患者被排除。我们按诊断年份调查了放射治疗、化疗和监测的比例，明确了与放射治疗率下降相关的特征，并按诊断年份分析了患者生存率。
1975年至2015年，52.9%（11622/21976）的I期精原细胞瘤患者接受了外照射放疗。然而，放射治疗率逐渐下降，2008年降至46.7%（189/405），2012年降至18.6%（70/376），2015年降至5.3%（19/359）。21世纪，34岁以下的患者和已婚患者更有可能避免接受放射治疗。与1975 - 1999年期间相比，2000 - 2007年患者的总生存期（OS）显著下降。然而，2008 - 2015年期间的OS与1975 - 1999年期间相比无统计学差异。
在过去40年中，放射治疗在I期精原细胞瘤患者中的作用发生了根本性变化，在该患者群体的实际管理中已不再是必不可少的治疗方法。
