Bower M, Brock C, Holden L, Nelstrop A, Makey A R, Rustin G J, Newlands E S
Medical Oncology Unit, Charing Cross Hospital, London, U.K.
Eur J Cancer. 1997 May;33(6):838-42. doi: 10.1016/s0959-8049(96)00403-0.
Mediastinal germ cell tumours (MGCT) are rare and most published series reflect the experiences of individual institutions over many years. Since 1979, we have treated 16 men (12 non-seminomatous germ cell tumours and 4 seminomas) with newly diagnosed primary MGCT with POMB/ACE chemotherapy and elective surgical resection of residual masses. This approach yielded complete remissions in 15/16 (94%) patients. The median follow-up was 6.0 years and no relapses occurred more than 2 years after treatment. The 5 year overall survival in the non-seminomatous germ cell tumours (NSGCT) is 73% (95% confidence interval 43-90%). One patient with NSGCT developed drug-resistant disease and died without achieving remission and 2 patients died of relapsed disease. In addition, 4 patients with bulky and/or metastatic seminoma were treated with POMB/ACE. One died of treatment-related neutropenic sepsis in complete remission and one died of relapsed disease. Finally, 4 patients (2 NSGCT and 2 seminomas) referred at relapse were treated with POMB/ACE and one was successfully salvaged. The combination of POMB/ACE chemotherapy and surgery is effective management for MGCT producing high long-term survival rates.
纵隔生殖细胞肿瘤（MGCT）较为罕见，大多数已发表的系列研究反映了个别机构多年来的经验。自1979年以来，我们采用POMB/ACE化疗及对残留肿块进行选择性手术切除的方法，治疗了16例新诊断的原发性MGCT男性患者（12例非精原细胞性生殖细胞肿瘤和4例精原细胞瘤）。该方法使15/16（94%）的患者获得完全缓解。中位随访时间为6.0年，治疗后2年以上未发生复发。非精原细胞性生殖细胞肿瘤（NSGCT）的5年总生存率为73%（95%置信区间43 - 90%）。1例NSGCT患者出现耐药性疾病，未缓解死亡，2例患者死于复发性疾病。此外，4例有大块肿瘤和/或转移性精原细胞瘤患者接受了POMB/ACE治疗。1例在完全缓解时死于与治疗相关的中性粒细胞减少性败血症，1例死于复发性疾病。最后，4例复发时转诊的患者（2例NSGCT和2例精原细胞瘤）接受了POMB/ACE治疗，1例成功挽救。POMB/ACE化疗与手术相结合对于MGCT是一种有效的治疗方法，可产生较高的长期生存率。
