Boyer M J, Cox K, Tattersall M H, Findlay M P, Grygiel J, Rogers J
Department of Medical Oncology, Royal Prince Alfred Hospital, Camperdown NSW, Australia.
Urology. 1997 Oct;50(4):588-92. doi: 10.1016/S0090-4295(97)00301-4.
To review the outcome of men with Stage I nonseminomatous germ cell tumors managed with a policy of active surveillance following orchiectomy.
The clinical records of all men with Stage I nonseminomatous germ cell tumors seen at Royal Prince Alfred Hospital, Australia between 1982 and 1995 were reviewed. Data were obtained concerning the histologic type of tumor, levels of serum tumor markers, relapse and subsequent treatment, and survival.
Seventy-seven patients were entered into the active surveillance protocol between 1982 and 1995. With a minimum follow-up of 2 years, 27 (35%) have relapsed, with a median time to relapse of 5 months. Two late relapses occurred at 37 and 57 months after diagnosis. Relapses occurred most commonly in the retroperitoneal lymph nodes, with the lungs the second most common site. Following treatment with chemotherapy and surgery, all patients achieved complete remission, with 1 patient subsequently relapsing and ultimately dying of progressive tumor. One other patient died of acute myeloid leukemia, thought to be secondary to chemotherapy. Overall, 75 patients (97%) remain alive and free of disease.
Active surveillance is a safe and effective approach to the management of Stage I nonseminomatous germ cell tumors. Although most relapses occur within the first 2 years, late relapses may occur.
回顾接受睾丸切除术后采用主动监测策略治疗的I期非精原细胞瘤性生殖细胞肿瘤男性患者的治疗结果。
回顾了1982年至1995年间在澳大利亚皇家阿尔弗雷德王子医院就诊的所有I期非精原细胞瘤性生殖细胞肿瘤男性患者的临床记录。获取了有关肿瘤组织学类型、血清肿瘤标志物水平、复发及后续治疗情况以及生存情况的数据。
1982年至1995年间，77例患者进入主动监测方案。在至少2年的随访中，27例（35%）复发，复发的中位时间为5个月。诊断后37个月和57个月各发生1例晚期复发。复发最常见于腹膜后淋巴结，肺部是第二常见部位。经过化疗和手术治疗后，所有患者均实现完全缓解，1例患者随后复发并最终死于肿瘤进展。另1例患者死于急性髓系白血病，被认为是化疗的继发结果。总体而言，75例患者（97%）仍存活且无疾病。
主动监测是治疗I期非精原细胞瘤性生殖细胞肿瘤的一种安全有效的方法。虽然大多数复发发生在头2年内，但也可能发生晚期复发。
