Goepel M, Recker F, Otto T, Krege S, Rübben H
Department of Urology, University of Essen Medical School, Germany.
Urol Int. 1996;57(4):209-12. doi: 10.1159/000282915.
Cisplatin-based chemotherapy is highly effective in non-seminomatous testicular cancer. Patients with advanced disease receive two to four cycles of polychemotherapy. Residual retroperitoneal masses after chemotherapy are suspected to contain active tumour tissue as well as mature teratoma. Therefore, a delayed retroperitoneal lymph node dissection remains necessary. A total of 123 patients with advanced non-seminomatous germ cell cancer underwent retroperitoneal surgery after two different regimes of cisplatin-based chemotherapy. The first group (n = 55) received a sequential alternating chemotherapy with Adriamycin/cisplatin and bleomycin/vinblastine (8.5 +/- 5 cycles, 1979-1985), the second group (n = 60) got a standard PEB scheme (cisplatinum /etoposide/bleomycin; 5.7 +/- 2.1 cycles, 1985-1991). Eight patients got other cisplatin-based combinations. All patients received adjunctive retroperitoneal surgery. After a mean follow-up period of 72 months, the patients treated with the sequential alternating scheme showed a survival rate of 50% (27/54, 1 patient lost to follow-up). After the PEB scheme a survival rate of 79% (46/58, 2 patients lost to follow-up) was found. 86% of the patients with retroperitoneal necrosis after retroperitoneal lymph node dissection (RPLND; n = 58) survived with no evidence of disease, as well as 82% of the patients with adult teratoma (n = 18). Only 47% of the patients with residual active carcinoma after RPLND (n = 47) survived within a follow-up period of (median) 72 months, despite further chemotherapy after RPLND. Residual tumor burden and type of histology after RPLND can partially predict the clinical outcome. A necrotic specimen in RPLND could not be predicted by any means, so that surgical removal of a residual retroperitoneal mass after chemotherapy remains necessary. Standard PEB chemotherapy is superior to sequential alternating chemotherapy.
基于顺铂的化疗在非精原细胞瘤性睾丸癌中疗效显著。晚期疾病患者接受两到四个周期的多药化疗。化疗后残留的腹膜后肿块被怀疑含有活跃的肿瘤组织以及成熟的畸胎瘤。因此，延迟性腹膜后淋巴结清扫术仍然是必要的。共有123例晚期非精原细胞瘤性生殖细胞癌患者在接受两种不同的基于顺铂的化疗方案后接受了腹膜后手术。第一组（n = 55）接受阿霉素/顺铂和博来霉素/长春花碱的序贯交替化疗（8.5±5个周期，1979 - 1985年），第二组（n = 60）采用标准的PEB方案（顺铂/依托泊苷/博来霉素；5.7±2.1个周期，1985 - 1991年）。8例患者接受了其他基于顺铂的联合方案。所有患者均接受了辅助性腹膜后手术。平均随访72个月后，接受序贯交替方案治疗的患者生存率为50%（27/54，1例患者失访）。采用PEB方案后，生存率为79%（46/58，2例患者失访）。腹膜后淋巴结清扫术（RPLND）后发生腹膜后坏死的患者中有86%（n = 58）无疾病证据存活，患有成人畸胎瘤的患者中有82%（n = 18）存活。尽管RPLND后进行了进一步化疗，但RPLND后残留活跃癌的患者中只有47%（n = 47）在（中位）72个月的随访期内存活。RPLND后的残留肿瘤负荷和组织学类型可以部分预测临床结果。RPLND中坏死标本无法通过任何方式预测，因此化疗后手术切除残留的腹膜后肿块仍然是必要的。标准的PEB化疗优于序贯交替化疗。
