Steyerberg E W, Donohue J P, Gerl A, Toner G C, Schraffordt Koops H, Fosså S D, Keizer H J
Department of Public Health, Erasmus University, Rotterdam, The Netherlands.
J Urol. 1997 Aug;158(2):474-8. doi: 10.1016/s0022-5347(01)64506-3.
We determined the need and sequence of retroperitoneal lymph node dissection and thoracotomy in patients with nonseminomatous testicular cancer, and with residual retroperitoneal and pulmonary masses after chemotherapy.
We studied 159 patients undergoing retroperitoneal lymph node dissection and a thoracotomy following cisplatin based induction chemotherapy for metastatic testicular nonseminomatous germ cell tumor. Several well-known predictors for residual histology (necrosis, mature teratoma and cancer) were evaluated.
As expected, necrosis was found more often at retroperitoneal lymph node dissection if the primary tumor was negative for teratoma, the residual mass was small or the decrease in size was great. Contrary, neither residual mass size nor the decrease in size was predictive of the histological status of the residual lung lesion. Histological findings in the retroperitoneum and lung were strongly correlated, such that necrosis at retroperitoneal lymph node dissection was associated with an 89% probability of necrosis in the lung.
Retroperitoneal lymph node dissection should be performed before thoracotomy is considered, since the histological status at dissection is a strong predictor of that at thoracotomy.
我们确定了非精原细胞瘤性睾丸癌患者以及化疗后有腹膜后和肺部残留肿块患者进行腹膜后淋巴结清扫术和开胸手术的必要性及顺序。
我们研究了159例接受基于顺铂的诱导化疗治疗转移性睾丸非精原细胞瘤性生殖细胞肿瘤后进行腹膜后淋巴结清扫术和开胸手术的患者。评估了几种众所周知的残留组织学（坏死、成熟畸胎瘤和癌）预测指标。
正如预期的那样，如果原发肿瘤为畸胎瘤阴性、残留肿块较小或缩小幅度较大，则在腹膜后淋巴结清扫术中更常发现坏死。相反，残留肿块大小和缩小幅度均不能预测残留肺部病变的组织学状态。腹膜后和肺部的组织学发现密切相关，以至于腹膜后淋巴结清扫术中的坏死与肺部坏死的概率为89%相关。
应在考虑开胸手术之前进行腹膜后淋巴结清扫术，因为清扫术中的组织学状态是开胸手术组织学状态的有力预测指标。
