Quaresma Vasco, Henriques Diogo, Marconi Lorenzo, Lorigo João, Ferreira Ana-Marta, Jarimba Roberto, Nunes Pedro, Figueiredo Arnaldo, Parada Belmiro
Urology Department, Centro Hospitalar e Universitário de Coimbra; Faculty of Medicine of the University of Coimbra.
Faculty of Medicine of the University of Coimbra.
Arch Ital Urol Androl. 2023 Sep 5;95(3):11513. doi: 10.4081/aiua.2023.11513.
Introdubction: Stage I seminoma has a very good prognosis, yet approximately 15% have subclinical metastatic disease and will relapse after orchidectomy alone. Several management approaches have been investigated. We aimed to evaluate the clinical outcomes of real-world patients with stage I seminoma, analysing prognostic factors influencing treatment choice and oncological outcomes.
Retrospective, single institution study, with 55 patients diagnosed with clinical stage I seminoma between 2007 and 2020. Selected patients were analysed regarding three management approaches - surveillance, adjuvant radiotherapy and adjuvant carboplatin AUC7. Overall survival and progression-free survival outcomes were analysed. Predictors of treatment choice were determined, and predictors of recurrence were analysed in patients on active surveillance.
The median follow-up time was 91 months (13-165). Overall survival at 10 years was 98.2%. Stage I seminoma patients had a 1-, 3- and 10-year progression free survival of 98%, 94% and 89%, respectively. Three-year progression free survival was 92.0% for those on active surveillance (IC95%, 91.5-92.5%), 95.2% for carboplatin (IC95%, 94.8-95.6%) and 100% for those on adjuvant radiotherapy (p > 0.05). All relapses on active surveillance protocols occurred during the first 24 months. Overall, 43% of patients who underwent adjuvant treatment reported adverse effects of therapy, with higher incidence on radiotherapy group (63%).
Stage I seminoma have excellent prognosis, high cure rates, and low treatment-associated morbidity. Active surveillance is a safe modality when applied to selected patients. Adjuvant radiotherapy and adjuvant chemotherapy with carboplatin show similar results, with fewer adverse effects on chemotherapy arm.
引言：I期精原细胞瘤预后非常好，但约15%的患者存在亚临床转移疾病，仅行睾丸切除术后会复发。已对多种治疗方法进行了研究。我们旨在评估真实世界中I期精原细胞瘤患者的临床结局，分析影响治疗选择和肿瘤学结局的预后因素。
一项回顾性单机构研究，纳入2007年至2020年间诊断为临床I期精原细胞瘤的55例患者。对所选患者分析了三种治疗方法——观察、辅助放疗和辅助卡铂AUC7化疗。分析总生存和无进展生存结局。确定治疗选择的预测因素，并对接受主动观察的患者分析复发的预测因素。
中位随访时间为91个月（13 - 165个月）。10年总生存率为98.2%。I期精原细胞瘤患者1年、3年和10年无进展生存率分别为98%、94%和89%。接受主动观察的患者3年无进展生存率为92.0%（95%置信区间，91.5 - 92.5%），接受卡铂化疗的患者为95.2%（95%置信区间，94.8 - 95.6%），接受辅助放疗的患者为100%（p>0.05）。主动观察方案下的所有复发均发生在最初24个月内。总体而言，43%接受辅助治疗的患者报告有治疗不良反应，放疗组发生率更高（63%）。
I期精原细胞瘤预后良好，治愈率高，治疗相关发病率低。主动观察应用于选定患者时是一种安全的方式。辅助放疗和卡铂辅助化疗显示相似结果，化疗组不良反应较少。
