Hernes E H, Harstad K
Department of Medical Oncology and Radiotherapy, Norwegian Radium Hospital, Oslo, Norway.
Eur Urol. 1996;30(3):349-57. doi: 10.1159/000474195.
The medical records of 352 patients with newly diagnosed testicular cancer were reviewed. Patients were orchiectomized during three 2-year periods (1981/82, 1986/87, 1991/92) and were referred for further treatment to the Norwegian Radium Hospital. They represented 96% of all cases with unilateral testicular cancer occurring within a defined area in the southern part of Norway.
An increase in testicular cancer patients was registered, mainly between the second and third time periods (61% increase). Gynaecomastia was recorded in 7% of all patients (seminoma: 6%; non-seminoma: 8%). Serum tumour markers (alpha-fetoprotein and/or human choriogonadotropin) were elevated before orchiectomy in 51% of the evaluated patients. During the studied 12-year period, considering seminoma and non-seminoma patients combined, the overall median delay decreased from 18 to 14 weeks (p = 0.006), the overall median diagnostic delay decreased from 14 to 10 weeks (p = 0.04) and the median treatment delay decreased from 37 to 28 days (p = 0.002). Due to increased frequency of stage I patients, introduction of an outpatient-based surveillance policy and improved administrative routines of the Health Care System, the median time of hospitalization was reduced from 37 (1981/82) to 9 days (1991/92). In seminoma, but not in non-seminoma patients, an overall delay of less than 16 weeks from the onset of symptoms was correlated with the incidence of stage I disease. The cancer-related 5-year survival rate for all 352 patients was 99%, without significant difference between the three periods under investigation. A patient's delay of more than 3 months was correlated with a significantly decreased 5-year survival rate if all patients are considered (p = 0.02).
(1) The significant increase of the incidence of testicular cancer in the southern part of Norway remains unexplained and warrants intensified search for aetiological factors of this malignancy. (2) The Health Care Service is challenged to make available sufficient resources for the rapid diagnosis, treatment and follow-up of the increasing number of new patients with testicular cancer, following modern principles of toxicity-reduced and resource-saving treatment. (3) Attempts should be made to shorten the patient's and doctor's delay by awareness campaigns and postgraduate education of general practitioners. The importance of the determination of serum tumour markers in patients with testicular masses should, in particular, be emphasized together with the significance of gynaecomastia in the young adult male.
回顾了352例新诊断睾丸癌患者的病历。患者在三个2年时间段（1981/82年、1986/87年、1991/92年）接受了睾丸切除术，并被转诊至挪威镭医院接受进一步治疗。他们代表了挪威南部特定区域内所有单侧睾丸癌病例的96%。
睾丸癌患者数量有所增加，主要在第二个和第三个时间段之间（增加了61%）。7%的患者出现了乳腺增生（精原细胞瘤：6%；非精原细胞瘤：8%）。在接受评估的患者中，51%在睾丸切除术前血清肿瘤标志物（甲胎蛋白和/或人绒毛膜促性腺激素）升高。在研究的12年期间，综合考虑精原细胞瘤和非精原细胞瘤患者，总体中位延迟从18周降至14周（p = 0.006），总体中位诊断延迟从14周降至10周（p = 0.04），中位治疗延迟从37天降至28天（p = 0.002）。由于I期患者数量增加、采用了基于门诊的监测策略以及医疗保健系统行政程序的改善，住院中位时间从37天（1981/82年）降至9天（1991/92年）。在精原细胞瘤患者中，但非精原细胞瘤患者中，症状出现后总体延迟少于16周与I期疾病的发生率相关。352例患者的癌症相关5年生存率为99%，在所研究的三个时间段之间无显著差异。如果考虑所有患者，患者延迟超过3个月与5年生存率显著降低相关（p = 0.02）。
（1）挪威南部睾丸癌发病率的显著增加原因不明，需要加强对这种恶性肿瘤病因的寻找。（2）医疗保健服务面临挑战，需要按照减少毒性和节约资源的现代治疗原则，为越来越多新的睾丸癌患者提供足够的资源用于快速诊断、治疗和随访。（3）应通过开展宣传活动和对全科医生进行研究生教育来努力缩短患者和医生的延迟。尤其应强调测定睾丸肿块患者血清肿瘤标志物的重要性以及乳腺增生在年轻成年男性中的意义。
