Mesnard Benoît, Hetet Jean-François, Couteau Emmanuel, Fosse Arthur, Bocquillon Vincent, Gignoux Alexis, Baron Michel, Gaschignard Nicolas, Rigaud Jérôme
Department of Urology and Transplantation Surgery, Nantes University Hospital, Nantes, France.
Clinique Jules Verne, Nantes, France.
Can Urol Assoc J. 2023 Aug;17(8):E236-E243. doi: 10.5489/cuaj.8239.
Management of testicular cancer requires a complete evaluation to confirm the localized stage and effective treatment according to guidelines to ensure the best outcome. The primary objective of this study was to evaluate practices at each stage of care in patients with a localized testicular tumor. The secondary objective was to evaluate the oncological prognosis of these patients according to the modalities of care.
We conducted a multicenter practice evaluation study with retrospective collection and evaluation of patient records. The study was conducted in two French departments (population pool of 2 million inhabitants) between January 1, 2010, and January 31, 2015, enabling a five-year followup of patients. Patients presenting with stage I testicular tumor according to the American Joint Committee on Cancer classification were included in the analysis.
A total of 226 records were analyzed; 93% of patients underwent bilateral scrotal ultrasound and 93.25% had a chest-abdomen-pelvis computed tomography scan. A total of 29.65% of patients had a preoperative tumor marker assay in accordance with guidelines; 94% of patients had a total orchiectomy, with a median time of 15 days. At the end of the followup period, 17 patients had suffered a recurrence of their disease. Providing adjuvant care in accordance with guidelines reduced the risk of recurrence in patients with a seminomatous tumor.
Our study showed heterogeneity in compliance with guidelines for evaluation and effective treatment of patients with a localized testicular tumor. Some essential practices, such as assays of tumor markers and fertility preservation for patients over 40 years, were not well carried out. Adjuvant management of localized tumors appears to be an important predictor of recurrence.
睾丸癌的管理需要进行全面评估以确认疾病局限期，并根据指南进行有效治疗，以确保最佳治疗效果。本研究的主要目的是评估局限性睾丸肿瘤患者在各个治疗阶段的实际治疗情况。次要目的是根据治疗方式评估这些患者的肿瘤学预后。
我们开展了一项多中心实际治疗情况评估研究，对患者记录进行回顾性收集和评估。该研究于2010年1月1日至2015年1月31日在法国的两个部门（居民人口总数为200万）进行，对患者进行了为期五年的随访。根据美国癌症联合委员会的分类标准，将呈现I期睾丸肿瘤的患者纳入分析。
共分析了226份记录；93%的患者接受了双侧阴囊超声检查，93.25%的患者进行了胸部-腹部-盆腔计算机断层扫描。共有29.65%的患者按照指南进行了术前肿瘤标志物检测；94%的患者接受了根治性睾丸切除术，中位时间为15天。在随访期结束时，17名患者疾病复发。按照指南提供辅助治疗可降低精原细胞瘤患者的复发风险。
我们的研究表明，在局限性睾丸肿瘤患者的评估和有效治疗指南的遵循方面存在异质性。一些基本操作，如肿瘤标志物检测以及为40岁以上患者保留生育功能，并未得到很好的实施。局限性肿瘤的辅助治疗似乎是复发的重要预测因素。
