Matsutani M, Sano K, Takakura K, Fujimaki T, Nakamura O, Funata N, Seto T
Department of Neurosurgery, University of Tokyo, Japan.
J Neurosurg. 1997 Mar;86(3):446-55. doi: 10.3171/jns.1997.86.3.0446.
The authors analyzed 153 cases of histologically verified intracranial germ cell tumors. The histological diagnosis was germinoma in 63 patients (41.2%), teratoma in 30 (19.6%), and other types of tumors in 60 patients (39.2%). The patients were treated by a consistent policy of surgical removal with histological verification followed by radiation therapy with or without chemotherapy. The 10- and 20-year survival rates of patients with pure germinoma were 92.7% and 80.6%, respectively. The 10-year survival rates of patients with mature teratoma and malignant teratoma were 92.9% and 70.7%, respectively. Patients with pure malignant germ cell tumors (embryonal carcinoma, yolk sac tumor, or choriocarcinoma) had a 3-year survival rate of 27.3%. The mixed tumors were divided into three subgroups: 1) mixed germinoma and teratoma; 2) mixed tumors whose predominant characteristics were germinoma or teratoma combined with some elements of pure malignant tumors; and 3) mixed tumors with predominantly pure malignant elements. The 3-year survival rates were 94.1% for the first group, 70% for the second group, and 9.3% for the third group, and the differences were statistically significant. Twenty-six patients with malignant tumors received chemotherapy that consisted of cisplatin and carboplatin combinations with or without radiation therapy. However, chemotherapy was not significantly more effective than radiation therapy alone. From these treatment results, the authors classified tumors into three groups with different prognoses and proposed a treatment guideline appropriate for the subgroups.
作者分析了153例经组织学证实的颅内生殖细胞肿瘤。组织学诊断为生殖细胞瘤的有63例患者（41.2%），畸胎瘤30例（19.6%），其他类型肿瘤60例（39.2%）。患者均采用一致的治疗策略，即手术切除并经组织学证实，随后根据情况进行放疗，可联合或不联合化疗。纯生殖细胞瘤患者的10年和20年生存率分别为92.7%和80.6%。成熟畸胎瘤和恶性畸胎瘤患者的10年生存率分别为92.9%和70.7%。纯恶性生殖细胞肿瘤（胚胎癌、卵黄囊瘤或绒毛膜癌）患者的3年生存率为27.3%。混合性肿瘤分为三个亚组：1）生殖细胞瘤和畸胎瘤混合；2）以生殖细胞瘤或畸胎瘤为主并伴有一些纯恶性肿瘤成分的混合性肿瘤；3）以纯恶性成分为主的混合性肿瘤。第一组的3年生存率为94.1%，第二组为70%，第三组为9.3%，差异具有统计学意义。26例恶性肿瘤患者接受了由顺铂和卡铂联合组成的化疗，可联合或不联合放疗。然而，化疗并不比单纯放疗更有效。根据这些治疗结果，作者将肿瘤分为预后不同的三组，并提出了适用于各亚组的治疗指南。
