Hentrich M U, Brack N G, Schmid P, Schuster T, Clemm C, Hartenstein R C
Department of Medicine IV, Munich Harlaching City Hospital, Germany.
Cancer. 1996 May 15;77(10):2109-16. doi: 10.1002/(SICI)1097-0142(19960515)77:10<2109::AID-CNCR22>3.0.CO;2-Y.
There has been evidence of a higher incidence of testicular germ cell tumors (GCT) in human immunodeficiency virus (HIV)-seropositive men than in the non HIV-infected male population. Most authors recommend standard therapy for HIV-positive patients with GCT but the immumosuppressive effects of chemotherapy and/or radiotherapy must be considered.
The records of all patients in whom testicular cancer was diagnosed and/or treated at a single institution between January 1986 and July 1995 were reviewed with regard to HIV seropositivity. Tumor histology, initial staging, treatment, and the patients' outcomes were analyzed in connection with a review of the literature.
Six patients with GCT and documented HIV seropositivity at the time of tumor diagnosis (four homosexuals, one bisexual, and one heterosexual former intravenous drug abuser) of 192 documented cases of testicular cancer are reported. In addition, 1 patient proved to be HIV seropositive 34 months after completing chemotherapy (vinblastine, ifosfamide, and cisplatin) for Stage IIB (minimal disease) seminoma. Intensified platinum-based chemotherapy was administered to two patients with clinical Stage IIIC (advanced disease) nonseminomatous germ cell tumors (NSGCT). Both patients achieved a transient partial response but suffered from progressive HIV disease and died 24 and 7 months, respectively, after orchiectomy. One patient with Stage IIIA (moderate disease) seminoma received four courses of chemotherapy (etoposide, ifosfamide, and cisplatin) and has remained in complete remission for 40 months. One patient with bilateral Stage I seminoma underwent adjuvant radiotherapy but was lost to follow-up. One patient with clinical Stage IIA (minimal disease) NSGCT refused any further treatment after hemiorchiectomy, but four courses of chemotherapy (cisplatin, etoposide and bleomycin) had to be given 32 months later because of symptomatic abdominal disease. A partial remission was obtained and there was no evidence of active tumor 16 months after the completion of chemotherapy. A retroperitoneal lymph node dissection was performed in 1 patient with Stage I NSGCT who was free of disease 111 months after diagnosis. The Centers for Disease Control classification for HIV infection and acquired immune deficiency syndrome (AIDS) did not change after therapy in two patients, whereas three patients suffered from progressive HIV disease.
HIV infection should be considered in patients with testicular cancer who belong to an urban population. Oncologic therapy based on a patient's individual situation is recommended.
有证据表明，人类免疫缺陷病毒（HIV）血清反应阳性男性的睾丸生殖细胞肿瘤（GCT）发病率高于未感染HIV的男性人群。大多数作者建议对HIV阳性的GCT患者采用标准治疗，但必须考虑化疗和/或放疗的免疫抑制作用。
回顾了1986年1月至1995年7月在单一机构诊断和/或治疗的所有睾丸癌患者的记录，以了解HIV血清反应阳性情况。结合文献综述，分析肿瘤组织学、初始分期、治疗及患者预后。
报告了192例记录在案的睾丸癌病例中，6例在肿瘤诊断时确诊为GCT且HIV血清反应阳性（4例同性恋者、1例双性恋者和1例异性恋前静脉吸毒者）。此外，1例患者在完成IIB期（微小病灶）精原细胞瘤的化疗（长春碱、异环磷酰胺和顺铂）34个月后被证明HIV血清反应阳性。2例临床IIIC期（晚期）非精原细胞生殖细胞肿瘤（NSGCT）患者接受了强化铂类化疗。2例患者均获得短暂部分缓解，但均患有进展性HIV疾病，分别在睾丸切除术后24个月和7个月死亡。1例IIIA期（中度病灶）精原细胞瘤患者接受了4个疗程的化疗（依托泊苷、异环磷酰胺和顺铂），目前已完全缓解40个月。1例双侧I期精原细胞瘤患者接受了辅助放疗，但失访。1例临床IIA期（微小病灶）NSGCT患者在半侧睾丸切除术后拒绝进一步治疗，但32个月后因有症状的腹部疾病不得不接受4个疗程的化疗（顺铂、依托泊苷和博来霉素）。化疗完成后16个月获得部分缓解，且无活性肿瘤证据。1例I期NSGCT患者在诊断后111个月无疾病，接受了腹膜后淋巴结清扫术。2例患者治疗后HIV感染和获得性免疫缺陷综合征（AIDS）的疾病控制中心分类未改变，而3例患者患有进展性HIV疾病。
城市人群中的睾丸癌患者应考虑HIV感染情况。建议根据患者个体情况进行肿瘤治疗。
