Department of Urology, Singapore General Hospital, Singapore.
Duke-NUS Medical School, Singapore, Singapore; Division of Medical Oncology, National Cancer Centre Singapore, Singapore.
Eur Urol Focus. 2024 May;10(3):377-379. doi: 10.1016/j.euf.2024.05.006. Epub 2024 Aug 3.
Testicular germ cell tumours (GCTs) account for the majority of testicular malignancies. Seminomas and nonseminomas differ in prognosis and management strategies. While cisplatin-based chemotherapy has significantly improved survival rates, identification of residual masses after chemotherapy is crucial for determining further treatment and survival. For seminomas, spontaneous resolution of residual masses occurs in a significant percentage of cases. Fluorodeoxyglucose positron emission tomography (FDG PET) is recommended for evaluation of residual masses after chemotherapy. Retroperitoneal lymph node dissection (RPLND) offers therapeutic benefits but is challenging because of an increase in desmoplasia after chemotherapy. For nonseminomas, residual masses are common after chemotherapy, with surgical resection necessary for masses larger than 1 cm. FDG PET has limited utility, and timely surgical intervention is crucial for favourable outcomes. Teratoma, if left unresected, can lead to serious complications, including growing teratoma syndrome, malignant transformation, and late relapse. Extraretroperitoneal residual masses, particularly those containing teratoma, are associated with poorer prognosis. Surgical resection remains the mainstay treatment, with significantly higher progression-free and recurrence-free survival rates for fibrosis/necrosis in comparison to teratoma or viable cancer. Understanding the characteristics and management of residual masses after chemotherapy is paramount for optimising treatment strategies and improving patient outcomes in testicular GCT. PATIENT SUMMARY: We reviewed treatment options for patients with testicular cancer who still have tumour tissue in the lower abdomen after chemotherapy. Surgical removal of the tumour is the main option; removal of lymph nodes can also help, but may be difficult because of tissue reactions to chemotherapy. Survival rates differ according to the tumour type and are lower for tumours beyond the lower abdomen.
睾丸生殖细胞肿瘤（GCT）占睾丸恶性肿瘤的大多数。精原细胞瘤和非精原细胞瘤在预后和治疗策略上有所不同。虽然基于顺铂的化疗显著提高了生存率，但确定化疗后残留肿块对于确定进一步的治疗和生存至关重要。对于精原细胞瘤，残留肿块在很大比例的病例中会自发消退。氟代脱氧葡萄糖正电子发射断层扫描（FDG PET）推荐用于评估化疗后残留肿块。腹膜后淋巴结清扫术（RPLND）具有治疗益处，但具有挑战性，因为化疗后会增加纤维变性。对于非精原细胞瘤，化疗后残留肿块很常见，对于大于 1cm 的肿块需要手术切除。FDG PET 的效用有限，及时进行手术干预对于获得良好的结果至关重要。如果未切除畸胎瘤，可能会导致严重的并发症，包括生长性畸胎瘤综合征、恶性转化和晚期复发。腹膜后以外的残留肿块，特别是含有畸胎瘤的残留肿块，与预后较差相关。手术切除仍然是主要的治疗方法，与畸胎瘤或存活的癌症相比，纤维化/坏死具有显著更高的无进展和无复发生存率。了解化疗后残留肿块的特征和管理对于优化治疗策略和改善睾丸 GCT 患者的预后至关重要。
我们回顾了化疗后下腹部仍有肿瘤组织的睾丸癌患者的治疗选择。手术切除肿瘤是主要选择；淋巴结切除也有帮助，但可能因化疗引起的组织反应而变得困难。根据肿瘤类型的不同，生存率也不同，下腹部以外的肿瘤生存率较低。
