Chavarriaga Julian, Clark Roderick, Atenafu Eshetu G, Anson-Cartwright Lynn, Warde Padraig, Chung Peter, Bedard Philippe L, Jiang Di Maria, O'Malley Martin, Prendeville Susan, Jewett Michael, Hamilton Robert J
Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, Canada; Department of Urology, Cancer Treatment and Research Centre, Luis Carlos Sarmiento Angulo Foundation, Bogota, Colombia.
Department of Urology, Penn State Cancer Institute, Hershey, PA, USA.
Eur Urol Focus. 2024 Oct 24. doi: 10.1016/j.euf.2024.10.004.
Studies in metastatic nonseminomatous germ-cell tumor (NSGCT) suggest that the presence of teratomatous elements in the primary tumor is a risk factor for poor survival. Many guidelines have extrapolated this observation and recommend adjuvant retroperitoneal lymph-node dissection (RPLND) even for clinical stage I (CSI) teratoma confined to the testicle. Our objective was to assess relapse-free survival (RFS), cancer-specific survival (CSS), overall survival (OS) among patients with CSI pure teratoma in comparison to CSI NSGCT.
Patients with CSI NSGCT managed with surveillance between 1980 and 2023 were identified in the prospectively maintained Princess Margaret Cancer Centre database. We compared cases with pure teratoma with or without somatic transformation in the primary tumor to all other nonteratomatous NSGCTs.
A total of 774 patients with CSI NSGCT were identified, including 63 (8.1%) with pure teratoma and/or somatic transformation in the primary tumor. Median follow-up was 61 mo. The pure teratoma group had superior RFS at 6 yr (85.2% vs 67.9%; p = 0.008). There were no significant differences in 6-yr CSS (100% vs 99.1%; p = 0.92) or OS (97.4% vs 98.1%; p = 0.33). Limitations include the single-center setting and the limited follow-up (median 61 mo), hindering the ability to detect late relapses.
CSI pure teratoma managed with surveillance is associated with a low risk of relapse overall and significantly lower risk of relapse in comparison to other CSI NSGCTs. No patients with CSI teratoma in the study population died of testicular cancer. Guidelines should be revised to include surveillance as a preferred approach for CSI teratoma.
We compared survival rates after testicle removal in clinical stage I testicular cancer for two different tumor types. We found that cancer-specific and overall survival rates were similar for pure teratoma tumors and nonseminoma tumors, and that the recurrence rate was lower for pure teratoma tumors. Our results support surveillance as a suitable option after surgery for patients with clinical stage I testicular teratoma.
转移性非精原细胞瘤性生殖细胞肿瘤（NSGCT）的研究表明，原发肿瘤中存在畸胎瘤成分是生存不良的一个危险因素。许多指南据此推断，甚至对于局限于睾丸的临床I期（CSI）畸胎瘤，也推荐进行辅助性腹膜后淋巴结清扫术（RPLND）。我们的目的是评估CSI纯畸胎瘤患者与CSI NSGCT患者的无复发生存率（RFS）、癌症特异性生存率（CSS）和总生存率（OS）。
在玛格丽特公主癌症中心前瞻性维护的数据库中，识别出1980年至2023年期间接受监测的CSI NSGCT患者。我们将原发肿瘤中有或无体细胞转化的纯畸胎瘤病例与所有其他非畸胎瘤性NSGCT进行了比较。
共识别出774例CSI NSGCT患者，其中63例（8.1%）原发肿瘤中有纯畸胎瘤和/或体细胞转化。中位随访时间为61个月。纯畸胎瘤组6年时的RFS更高（85.2%对67.9%；p = 0.008）。6年CSS（100%对99.1%；p = 0.92）或OS（97.4%对98.1%；p = 0.33）无显著差异。局限性包括单中心研究环境和有限的随访时间（中位61个月），这妨碍了检测晚期复发的能力。
接受监测的CSI纯畸胎瘤总体复发风险较低，与其他CSI NSGCT相比复发风险显著更低。研究人群中没有CSI畸胎瘤患者死于睾丸癌。应修订指南，将监测作为CSI畸胎瘤的首选方法。
我们比较了两种不同肿瘤类型的临床I期睾丸癌患者睾丸切除术后的生存率。我们发现，纯畸胎瘤肿瘤和非精原细胞瘤肿瘤的癌症特异性生存率和总生存率相似，且纯畸胎瘤肿瘤的复发率更低。我们的结果支持将监测作为临床I期睾丸畸胎瘤患者术后的合适选择。
