Germa Lluch J R, Climent M A, Villavicencio H, Gomez de Segura G, Blanco R, Mercedes A, de Andres L, Sole Balcells F J
Medical Oncology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain.
Br J Urol. 1993 Apr;71(4):473-7. doi: 10.1111/j.1464-410x.1993.tb15996.x.
Between 1980 and 1989, 138 patients with stage I carcinoma of the testes were treated and followed up; 81 patients had seminoma and 57 had non-seminomatous tumours. Between January 1980 and December 1983, patients with seminoma were treated by orchiectomy, followed by complementary radiotherapy to aortic and ipsilateral pelvic nodes. Retroperitoneal lymph node dissection (RPLND) was performed in patients with non-seminomatous tumours. After January 1984 the treatment strategy was changed and orchiectomy was followed by a surveillance policy in all histological types. In seminoma patients, 1 of 36 patients (3%) treated with complementary radiotherapy and 5 of 45 (11%) on the surveillance policy relapsed. All achieved a complete response after chemotherapy. In non-seminomatous tumours, 3 of 21 patients (14%) treated with complementary lymphadenectomy relapsed, in contrast to 11 of 36 (31%) surveillance policy patients. All patients who relapsed obtained a complete response with chemotherapy. All patients are currently free of disease. There were no differences in survival between both treatment policies. We conclude that a wait and see policy in stage I testicular tumours is feasible and provides the same results as more interventionist practices.
1980年至1989年间，对138例睾丸I期癌患者进行了治疗和随访；其中81例为精原细胞瘤患者，57例为非精原细胞瘤患者。1980年1月至1983年12月期间，精原细胞瘤患者接受睾丸切除术，随后对主动脉和同侧盆腔淋巴结进行辅助放疗。非精原细胞瘤患者则进行腹膜后淋巴结清扫术（RPLND）。1984年1月以后，治疗策略发生了改变，所有组织学类型的患者在睾丸切除术后均采取监测策略。在精原细胞瘤患者中，接受辅助放疗的36例患者中有1例（3%）复发，采取监测策略的45例患者中有5例（11%）复发。所有复发患者在化疗后均实现完全缓解。在非精原细胞瘤患者中，接受辅助淋巴结清扫术的21例患者中有3例（14%）复发，而采取监测策略的36例患者中有11例（31%）复发。所有复发患者经化疗后均实现完全缓解。目前所有患者均无疾病。两种治疗策略的生存率无差异。我们得出结论，对I期睾丸肿瘤采取观望策略是可行的，并且与更多干预性治疗方法的效果相同。
