Li Puhan, Ma Yucheng, Liao Banghua
Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China.
Transl Androl Urol. 2024 Jul 31;13(7):1180-1187. doi: 10.21037/tau-23-544. Epub 2024 Jul 9.
The 8 edition of the American Joint Committee on Cancer (AJCC) manual divides T1 stage testicular cancer into T1a and T1b, but it is only applicable to seminoma. The purpose of this observational study is to discuss further the possibility of extending this classification system to any T1 testicular cancer.
Testicular cancer patients from 2000 to 2018 in the Surveillance, Epidemiology, and End Results (SEER) database were included in this analysis. After patient selection, univariate and multivariate Cox regression were used to evaluate the impact of tumor size on survival in patients with T1 testicular cancer. A time-dependent receiver operation curve (ROC) was used to determine the best tumor size cut-off value for further T1 subgroup classification. Restricted cubic splines (RCS) analysis was used to compare different tumor sizes with the best tumor size cut-off value. Propensity score matching (PSM) analysis was conducted to generate baseline balanced data to validate findings.
A total of 6,630 patients were included in this study. In the Cox regression model, we found that T1b staged tumor (>34 mm) was an independent risk factor of overall survival [OS, adjusted hazard ratio (HR): 1.57, 95% confidence interval (CI): 1.12-2.21] and cancer-specific survival (CSS, adjusted HR: 5.027, 95% CI: 1.95-12.93). Further PSM analysis consolidated our results.
For any T1 testicular cancer, a tumor size of 34 mm could be used as the demarcation point to assess the prognosis. Adopting personalized treatments and follow-up plans may help improve the OS and CSS rate for testicular cancer patients.
美国癌症联合委员会（AJCC）第8版手册将T1期睾丸癌分为T1a和T1b，但仅适用于精原细胞瘤。本观察性研究的目的是进一步探讨将该分类系统扩展至所有T1期睾丸癌的可能性。
本分析纳入了监测、流行病学和最终结果（SEER）数据库中2000年至2018年的睾丸癌患者。患者选择后，采用单因素和多因素Cox回归评估肿瘤大小对T1期睾丸癌患者生存的影响。采用时间依赖性受试者工作特征曲线（ROC）确定进一步进行T1亚组分类的最佳肿瘤大小临界值。使用受限立方样条（RCS）分析比较不同肿瘤大小与最佳肿瘤大小临界值。进行倾向评分匹配（PSM）分析以生成基线平衡数据来验证研究结果。
本研究共纳入6630例患者。在Cox回归模型中，我们发现T1b期肿瘤（>34 mm）是总生存[OS，调整后风险比（HR）：1.57，95%置信区间（CI）：1.12 - 2.21]和癌症特异性生存（CSS，调整后HR：5.027，95%CI：1.95 - 12.93）的独立危险因素。进一步的PSM分析巩固了我们的结果。
对于所有T1期睾丸癌，肿瘤大小34 mm可作为评估预后的分界点。采用个性化治疗和随访计划可能有助于提高睾丸癌患者的OS和CSS率。
