Moore Joseph A, Slack Rebecca S, Lehner Michael J, Campbell Matthew T, Shah Amishi Y, Zhang Miao, Guo Charles C, Ward John F, Karam Jose A, Wood Christopher G, Pisters Louis L, Tu Shi-Ming
Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Cancers (Basel). 2022 Feb 23;14(5):1127. doi: 10.3390/cancers14051127.
Background. Very late recurrence (LR), i.e., >5 years after initial presentation, occurs in about 1% of patients with germ cell tumors of the testis (TGCT) and is associated with poor prognosis. Methods. We retrospectively reviewed the records of patients at the M. D. Anderson Cancer Center who developed LR > 5 years after their initial diagnosis of TGCT. Results. We identified 25 patients who developed LR between July 2007 and August 2020. The median age at the time of LR was 46 years (range, 29−61). Pathology of LR: somatic transformation to carcinoma or sarcoma—11, nonseminoma with yolk sac tumor or teratoma—11, nonseminoma without yolk sac tumor or teratoma—2, not available—1. With a median follow-up of 3.5 years, 68% of patients are alive 3 years after LR. Patients with prior post-chemotherapy consolidation surgery do not have statistically significant longer survival compared to patients who did not receive post-chemotherapy consolidation surgery, 83.3% vs. 60.8% at 3 years, respectively, p = 0.50. Conclusions. Patients with LR > 5 years tend to harbor nonseminoma (with yolk sac tumor and or teratoma). Among these patients, a majority who did not undergo surgery to remove residual disease after chemotherapy developed somatic transformation and succumbed to their LR.
背景。极晚期复发（LR），即初次就诊后超过5年出现复发，发生在约1%的睾丸生殖细胞肿瘤（TGCT）患者中，且与预后不良相关。方法。我们回顾性分析了MD安德森癌症中心初次诊断为TGCT后5年以上出现LR的患者记录。结果。我们确定了25例在2007年7月至2020年8月期间出现LR的患者。LR发生时的中位年龄为46岁（范围29 - 61岁）。LR的病理类型：向癌或肉瘤的体细胞转化——11例，伴有卵黄囊瘤或畸胎瘤的非精原细胞瘤——11例，无卵黄囊瘤或畸胎瘤的非精原细胞瘤——2例，未提供——1例。中位随访3.5年，68%的患者在LR后3年存活。与未接受化疗后巩固手术的患者相比，接受过化疗后巩固手术的患者在统计学上没有显著更长的生存期，3年时分别为83.3%和60.8%，p = 0.50。结论。LR超过5年的患者往往患有非精原细胞瘤（伴有卵黄囊瘤和/或畸胎瘤）。在这些患者中，大多数在化疗后未接受手术切除残留病灶的患者发生了体细胞转化并死于LR。
