Dieckmann Klaus-Peter, Angerer Markus, Bremmer Felix, Soave Armin
Asklepios Klinik Altona, Urologische Abteilung, Hodentumorzentrum, Paul Ehrlich Straße 1, 22763, Hamburg, Deutschland.
Institut für Pathologie, Universitätsmedizin Göttingen, Göttingen, Deutschland.
Urologie. 2025 Sep 20. doi: 10.1007/s00120-025-02675-6.
Systematic follow-up (FU) examinations in patients with testicular germ cell tumors (GCTs) came into practice in the 1980s. The goal is to detect recurrent disease as early as possible to facilitate successful treatment. Cross-sectional imaging and tumor marker measurements (AFP, bHCG) represent the mainstay of FU examinations. Due to the biological and clinical diversity of GCTs, there is no uniform general pattern of examinations that would suit all GCT patients. Therefore, FU should be performed in a risk-adapted way; the rationale of which is to tailor examinations to the extent needed, while keeping examinations as short as possible. In the entire population of testicular GCTs, there are around 20 different risk categories that are characterized by histology, clinical stage, and antecedent treatment and that differ from each other with respect to frequency of relapses (2-50%), time interval to relapse, and topography of recurrent disease. In terms of clinical practice, three risk groups should be employed: (1) seminoma all stages, (2) nonseminoma clinical stage 1, and (3) nonseminoma all other clinical stages. The FU examinations specifically required in these categories are listed in three roster tables, accordingly. The following items are at variance with the German S3 guidelines from 2019: (a) the number of risk groups is reduced to three (instead of 4) and the groups are newly defined, (b) cross-sectional imaging with computed tomography (CT) is replaced by magnetic resonance imaging (MRI) for reasons of radiation protection, (c) abdominal sonography is replaced by MRI for reasons of superior diagnostic accuracy, (d) no more chest X‑ray in FU of seminoma patients, and (e) lactate dehydrogenase (LDH) no longer a marker for testing in FU. Another goal of FU is the early detection of second diseases ensuing from treatment of GCT such as hypogonadism, metabolic syndrome, cardiovascular diseases, and second malignancies. Therefore, FU should be continued beyond the 5 year threshold with annual visits.
对睾丸生殖细胞肿瘤（GCT）患者进行系统随访检查始于20世纪80年代。目的是尽早发现复发性疾病，以便成功治疗。横断面成像和肿瘤标志物测量（甲胎蛋白、β人绒毛膜促性腺激素）是随访检查的主要手段。由于GCT的生物学和临床多样性，不存在适用于所有GCT患者的统一常规检查模式。因此，随访应根据风险进行调整；其基本原理是根据需要进行相应程度的检查，同时尽量缩短检查时间。在整个睾丸GCT患者群体中，约有20种不同的风险类别，其特征包括组织学、临床分期和前期治疗情况，且在复发频率（2% - 50%）、复发时间间隔以及复发性疾病的部位方面各不相同。在临床实践中，应采用三个风险组：（1）各期精原细胞瘤，（2）非精原细胞瘤临床分期1期，（3）非精原细胞瘤所有其他临床分期。相应地，这三个类别具体所需的随访检查列在三个名册表中。以下各项与2019年德国S3指南不同：（a）风险组数量减至三个（而非4个）且重新定义，（b）出于辐射防护原因，用磁共振成像（MRI）取代计算机断层扫描（CT）进行横断面成像，（c）出于诊断准确性更高的原因，用MRI取代腹部超声检查，（d）精原细胞瘤患者随访时不再进行胸部X光检查，（e）乳酸脱氢酶（LDH）不再作为随访检测标志物。随访的另一个目标是早期发现GCT治疗后引发的第二种疾病，如性腺功能减退、代谢综合征、心血管疾病和第二种恶性肿瘤。因此，随访应在5年期限之后继续，每年进行一次检查。
