Warde P, Gospodarowicz M K, Panzarella T, Catton C N, Sturgeon J F, Moore M, Goodman P, Jewett M A
Department of Radiation Oncology, University of Toronto, Canada.
J Clin Oncol. 1995 Sep;13(9):2255-62. doi: 10.1200/JCO.1995.13.9.2255.
To assess the results of treatment and patterns of relapse in a contemporary group of patients with stage I testicular seminoma managed by adjuvant radiation therapy (RT) and surveillance.
Between January 1981 and December 1991, 364 patients with stage I seminoma were treated at Princess Margaret Hospital. Of these, 194 were treated with adjuvant RT (92% received a dose of 25 Gy in 20 fractions for 4 weeks) and 172 were managed by surveillance. Two patients were included in this series twice--both had postorchiectomy RT for stage I disease, developed a contralateral seminoma, and were placed on surveillance and analyzed for outcome of both primary tumors. The median follow-up period for patients treated with adjuvant RT was 8.1 years (range, 0.2 to 12), and for patients managed by surveillance, it was 4.2 years (range, 0.6 to 10.1).
The overall 5-year actuarial survival rate for all patients was 97%, and the cause-specific survival rate was 99.7%. Only one patient died of seminoma. Of 194 patients treated with RT, 11 have relapsed, with a 5-year relapse-free rate of 94.5%. Prognostic factors for relapse included histology, tunica invasion, spermatic cord involvement, and epididymal involvement. Twenty-seven patients developed disease progression on surveillance, which resulted in a 5-year progression-free rate of 81.9%. The only factor identified to predict progression on surveillance was age at diagnosis: patients aged < or = 34 years had a 26% risk of progression at 5 years, in contrast to a 10% risk of progression in those greater than 34 years of age.
The outcome of patients with stage I testicular seminoma is excellent, with only one of 364 patients (0.27%) dying of disease. In our experience, both a policy of adjuvant RT and of surveillance resulted in a high probability of cure. Our surveillance experience showed that four of five patients with stage I seminoma are cured with orchiectomy alone. The benefit of adjuvant RT was reflected in a decreased relapse rate. We have identified a number of prognostic factors for relapse in patients managed with both approaches, but further study of prognostic factors is required, particularly to identify patients at high risk of disease progression on surveillance.
评估一组采用辅助放疗（RT）和监测治疗的当代I期睾丸精原细胞瘤患者的治疗结果和复发模式。
1981年1月至1991年12月期间，玛格丽特公主医院收治了364例I期精原细胞瘤患者。其中，194例接受辅助放疗（92%的患者在4周内分20次接受25 Gy的剂量），172例接受监测。两名患者被纳入本系列两次——两人均因I期疾病接受睾丸切除术后放疗，随后对侧发生精原细胞瘤，之后接受监测并分析两个原发性肿瘤的结果。接受辅助放疗患者的中位随访期为8.1年（范围0.2至12年），接受监测患者的中位随访期为4.2年（范围0.6至10.1年）。
所有患者的5年总精算生存率为97%，病因特异性生存率为99.7%。仅1例患者死于精原细胞瘤。在194例接受放疗的患者中，11例复发，5年无复发生存率为94.5%。复发的预后因素包括组织学、白膜侵犯、精索受累和附睾受累。27例接受监测的患者出现疾病进展，5年无进展率为81.9%。唯一被确定可预测监测期疾病进展的因素是诊断时的年龄：年龄≤34岁的患者5年进展风险为26%，而年龄大于34岁的患者进展风险为10%。
I期睾丸精原细胞瘤患者的预后良好，364例患者中仅1例（0.27%）死于该病。根据我们的经验，辅助放疗和监测策略均有很高的治愈概率。我们的监测经验表明，五分之四的I期精原细胞瘤患者仅通过睾丸切除术即可治愈。辅助放疗的益处体现在复发率降低。我们已确定了两种治疗方法患者复发的一些预后因素，但仍需要进一步研究预后因素，特别是要确定监测期疾病进展高危患者。
