Vugrin D, Whitmore W F
Cancer. 1985 May 1;55(9):1874-8. doi: 10.1002/1097-0142(19850501)55:9<1874::aid-cncr2820550905>3.0.co;2-j.
This study evaluates the effect of combination chemotherapy on retroperitoneal metastases from nonseminomatous germ cell tumors of the testis (NSGCTT). Sixty-six patients with Stage III or bulky Stage II NSGCTT with clinically documented retroperitoneal metastases first received systemic chemotherapy. Seventeen patients had minimal and 49 had advanced retroperitoneal metastases. The retroperitoneal metastases were classified as advanced if the patient had a palpable retroperitoneal mass, ureteral deviation on intravenous pyelogram, or a mass with a diameter greater than or equal to 5 cm documented by a computerized axial tomographic scan, a pedal lymphangiogram, or surgery. The patients with lesser but clinically evident retroperitoneal metastatic deposits were considered to have minimal retroperitoneal metastases. A complete remission of retroperitoneal metastatic deposits was achieved in 50 (76%) patients, with chemotherapy alone in 25 (38%), and with combined chemotherapy and surgery in 25 (38%). The resected deposits consisted of mature teratoma in 15 and malignant elements in 10. A complete remission using chemotherapy alone occurred in 13 of 17 (76%) with minimal and in 12/49 (24%) with advanced retroperitoneal metastases, and in 17/30 (57%) without and 8/36 (22%) with teratoma in the testis tumor. The data strongly implied that the bulk of the metastatic deposits was a more important prognostic variable than the histology of the primary tumor. The adverse relationship of a teratomatous differentiation on the response rates with chemotherapy alone was offset by the success of supplemental surgery. This study suggests the benefit of a postchemotherapy retroperitoneal lymph node dissection (RPLND) in patients with initially bulky retroperitoneal metastases (complete response [CR] increased from 24% to 67%; an additional 47% patients had no evidence of disease). The patients with minimal retroperitoneal metastases usually achieved a CR with chemotherapy alone. A routine RPLND after the chemotherapy is not indicated in patients with initially minimal retroperitoneal metastases.
本研究评估了联合化疗对睾丸非精原细胞性生殖细胞肿瘤（NSGCTT）腹膜后转移的疗效。66例临床记录有腹膜后转移的Ⅲ期或大块Ⅱ期NSGCTT患者首先接受全身化疗。17例患者腹膜后转移灶微小，49例患者腹膜后转移灶进展。如果患者可触及腹膜后肿块、静脉肾盂造影显示输尿管移位，或计算机断层扫描、足背淋巴管造影或手术记录肿块直径大于或等于5 cm，则腹膜后转移灶被分类为进展期。腹膜后转移灶较小但临床上明显的患者被认为有微小腹膜后转移。50例（76%）患者腹膜后转移灶完全缓解，其中单纯化疗25例（38%），化疗联合手术25例（38%）。切除的转移灶中，15例为成熟畸胎瘤，10例为恶性成分。单纯化疗使17例微小腹膜后转移患者中的13例（76%）、49例进展期腹膜后转移患者中的12例（24%）、睾丸肿瘤无畸胎瘤的30例患者中的17例（57%）以及有畸胎瘤的36例患者中的8例（22%）完全缓解。数据强烈表明，转移灶的大小比原发肿瘤的组织学更重要的预后变量。单纯化疗时畸胎瘤分化对缓解率的不利关系被补充手术的成功所抵消。本研究表明，对于最初腹膜后转移灶较大的患者，化疗后腹膜后淋巴结清扫术（RPLND）有益（完全缓解率从24%提高到67%；另外47%的患者无疾病证据）。腹膜后转移灶微小的患者通常单纯化疗即可达到完全缓解。对于最初腹膜后转移灶微小的患者，化疗后不建议常规进行RPLND。
