Fosså S D, Jacobsen A B, Aass N, Heilo A, Stenwig A E, Kummen O, Johannessen N B, Waaler G, Ogreid P, Borge L
Department of Medical Oncology, Norwegian Radium Hospital, Oslo.
Br J Cancer. 1994 Dec;70(6):1156-60. doi: 10.1038/bjc.1994.464.
In patients with clinical stage I non-seminomatous testicular cancer only limited information is available about the administrative problems with the surveillance programme, in particular if this policy is to be implemented in a geographically extended country with limited computerised tomography (CT) resources. One hundred and two patients with non-seminomatous testicular cancer clinical stage I and low-risk histology (MRC criteria, UK) were followed by the surveillance policy for at least 1 year after orchiectomy (median 47 months, range 21-81 months). Twenty-two patients (22%) relapsed after a median time of 5 months (range 2-18 months), 14 of them in the retroperitoneal space. Serum alpha-fetoprotein and/or human chorionic gonadotrophin were elevated in eight of the 22 relapsing patients. The progression-free and cancer-corrected survival rates were 78% and 99% respectively. Patient non-compliance did not represent a major problem, whereas the regular and adequate performance of necessary CT examinations yielded some administrative difficulties. One and 3 years after orchiectomy about 50% of the relapse-free patients had no psychological problems and were satisfied with the surveillance programme, whereas 46% reported minor and 4% major psychological distress. Despite non-negligible administrative difficulties in geographically extended countries, surveillance is feasible and safe in compliant patients with low-risk non-seminomatous testicular cancer stage I. The responsible cancer centre and the local hospitals should establish a high degree of cooperation and enable adequate follow-up examinations in these patients.
对于临床I期非精原细胞瘤性睾丸癌患者，关于监测计划中的管理问题，可获取的信息有限，特别是如果要在一个计算机断层扫描（CT）资源有限且地域广阔的国家实施这一政策时。102例临床I期且组织学为低风险（英国MRC标准）的非精原细胞瘤性睾丸癌患者在睾丸切除术后接受了至少1年的监测（中位时间47个月，范围21 - 81个月）。22例患者（22%）在中位时间5个月（范围2 - 18个月）后复发，其中14例在腹膜后间隙复发。22例复发患者中有8例血清甲胎蛋白和/或人绒毛膜促性腺激素升高。无进展生存率和癌症校正生存率分别为78%和99%。患者不依从并非主要问题，而必要CT检查的定期且充分实施存在一些管理困难。睾丸切除术后1年和3年，约50%无复发的患者没有心理问题且对监测计划满意，而46%报告有轻微心理困扰，4%报告有严重心理困扰。尽管在地域广阔的国家存在不可忽视的管理困难，但对于依从性好的低风险I期非精原细胞瘤性睾丸癌患者，监测是可行且安全的。负责的癌症中心和当地医院应建立高度合作关系，并确保对这些患者进行充分的随访检查。
