Department of Urology, University of Zurich, Zurich, Switzerland.
Department of Oncology, Inselspital Bern, University of Bern, Bern, Switzerland.
World J Urol. 2022 Sep;40(9):2293-2303. doi: 10.1007/s00345-022-04048-6. Epub 2022 Jul 12.
In several urogenital cancers, organ-preserving surgery represents the preferred treatment approach, but in patients with testicular germ cell tumors (tGCTs), radical orchiectomy represents the standard of care. This study aimed to summarize published case series assessing oncological and functional outcomes after testis-sparing surgery (TSS) in patients with tGCTs.
A systematic literature review and individual patient data meta-analysis were conducted of published cases with tGCT treated with TSS.
Of 2,333 reports, we included 32 reports providing data on 285 patients, including 306 testicles treated with TSS. Adjacent germ cell neoplasia in situ (GCNIS) was described in 43%. Hypogonadism and infertility after TSS were diagnosed in 27% and 18%. In patients undergoing adjuvant testicular radiotherapy, hypogonadism was diagnosed in 40%. Patients treated with adjuvant testicular radiotherapy after TSS exhibited a significantly lower incidence of local recurrence (2% vs. 50%, p < 0.001). Distant metastases after TSS were observed in 2%.
The current data questions the benefits of TSS in tGCT patients. If at all, TSS should only be offered to well-informed patients with a singular testicle, excellent compliance, a singular tumor less than 2 cm located at the lower pole of the testicle, and normal preoperative endocrine function. Unless patients plan to father a child within a short time frame, adjuvant testicular radiotherapy should be recommended after TSS. Radical orchiectomy remains the standard of care, but future studies may support the use of TSS in selected men.
在几种泌尿生殖系统癌症中，保留器官的手术是首选治疗方法，但在睾丸生殖细胞肿瘤（tGCT）患者中，根治性睾丸切除术是标准治疗方法。本研究旨在总结评估 tGCT 患者行保留睾丸手术（TSS）后的肿瘤学和功能结局的已发表病例系列研究。
对已发表的采用 TSS 治疗 tGCT 的病例进行了系统的文献回顾和个体患者数据荟萃分析。
在 2333 份报告中，我们纳入了 32 份报告，提供了 285 例患者的数据，其中 306 例睾丸接受了 TSS 治疗。描述了 43%的相邻生殖细胞原位肿瘤（GCNIS）。TSS 后诊断出 27%的患者存在性腺功能减退和 18%的患者存在不育。接受辅助睾丸放疗的患者中，性腺功能减退的诊断率为 40%。TSS 后接受辅助睾丸放疗的患者局部复发率明显较低（2%对 50%，p<0.001）。TSS 后观察到远处转移 2%。
目前的数据对 TSS 在 tGCT 患者中的益处提出了质疑。如果有的话，TSS 仅应提供给有一个睾丸、良好的依从性、单个肿瘤小于 2 厘米且位于睾丸下极、术前内分泌功能正常的知情患者。除非患者计划在短期内生育，否则应在 TSS 后推荐辅助睾丸放疗。根治性睾丸切除术仍然是标准治疗方法，但未来的研究可能支持在选定的男性中使用 TSS。
