von der Maase H, Specht L, Jacobsen G K, Jakobsen A, Madsen E L, Pedersen M, Rørth M, Schultz H
Department of Oncology, Aarhus University Hospital, Denmark.
Eur J Cancer. 1993;29A(14):1931-4. doi: 10.1016/0959-8049(93)90446-m.
From 1985 to 1988, 261 unselected patients entered a nationwide Danish study of surveillance only for testicular seminoma stage I. The median follow-up time after orchidectomy was 48 months, range 6-67 months. 49 patients relapsed (19%). Sites of relapse were paraaortic lymph nodes in 41 patients, pelvic lymph nodes in 5, inguinal lymph nodes in 2 and lung metastases in 1 patient. The median time to relapse was 14 months, range 2-37 months. The 4-year relapse-free survival was 80%. 37 of the relapsing patients (76%) had radiotherapy as relapse treatment. Of these patients, 4 (11%) had a second relapse and received chemotherapy. 1 died of disseminated seminoma. Of the relapsing patients, 12 (24%) had chemotherapy as relapse treatment because of bulky (11 patients) or disseminated disease (1 patient). None of these patients have had a second relapse. However, 2 patients died of infection due to chemotherapy-induced neutropenia. Thus, there have been three seminoma-related deaths (1.1%). The testicular tumour size had an independent prognostic significance. The 4-year relapse-free survivals were 94, 82 and 64% for tumours < 3, 3 to < 6 and > or = 6 cm, respectively. Patients with tumours > or = 6 cm will now be given prophylactic radiation treatment, whereas we will continue to use surveillance only after orchidectomy for patients with tumours < 6 cm.
1985年至1988年期间，261例未经挑选的患者进入了一项丹麦全国性的仅针对睾丸精原细胞瘤I期的监测研究。睾丸切除术后的中位随访时间为48个月，范围为6至67个月。49例患者复发（19%）。复发部位为腹主动脉旁淋巴结41例、盆腔淋巴结5例、腹股沟淋巴结2例和肺转移1例。复发的中位时间为14个月，范围为2至37个月。4年无复发生存率为80%。37例复发患者（76%）接受了放疗作为复发治疗。在这些患者中，4例（11%）出现第二次复发并接受了化疗。1例死于播散性精原细胞瘤。在复发患者中，12例（24%）因肿块较大（11例）或疾病播散（1例）接受了化疗作为复发治疗。这些患者均未出现第二次复发。然而，2例患者死于化疗引起的中性粒细胞减少导致的感染。因此，共有3例与精原细胞瘤相关的死亡（1.1%）。睾丸肿瘤大小具有独立的预后意义。肿瘤<3 cm、3至<6 cm以及≥6 cm的4年无复发生存率分别为94%、82%和64%。肿瘤≥6 cm的患者现在将接受预防性放射治疗，而对于肿瘤<6 cm的患者，我们将继续仅在睾丸切除术后进行监测。
