Drianno N, Robert M, Legouffe E, Guiter J, Navratil H
Service d'Urologie I, Hôpital Lapeyronie, CHU de Montpellier, France.
Prog Urol. 1997 Sep;7(4):622-7.
To evaluate the prognosis and therapeutic modalities of stage I nonseminomatous germ cell tumours of the testis (NSGT) with an embryonic carcinomatous component (EC).
18 patients with stage I nonseminomatous germ cell tumour of the testis with an embryonic carcinomatous component were treated between 1987 and 1995. EC represented more than 50% of the testicular tumour mass in 15 cases. This tumour contingent constituted the only potential prognostic factor in 4 cases, but vascular or lymphatic emboli (n = 3), tumour stage > pT1 (n = 5) or absence of endodermal sinus component (n = 9) were observed in 14 cases. The first 3 patients underwent retroperitoneal lymph node dissection and the following 15 patients were submitted to surveillance (n = 4) or chemotherapy (n = 11) according to the PVB [Cisplatin, Vinblastine, Bleomycin] (n = 7) or BOE [bleomycin, Etoposide, Cisplatin] (n = 4) protocols.
With a follow-up of 10 to 110 months (mean: 46), the survival rate is 100% and the recurrence rate is 22%. None of the patients with a local stage exceeding pT1 relapsed after chemotherapy. 2 patients in whom the EC contingent represented less than 50% of the tumour mass and who were simply watched, did not relapse. 4 relapses, detected 3 to 14 months after orchidectomy (mean: 8.5), during surveillance (n = 2) or after chemotherapy (n = 2), required surgical resection or complementary chemotherapy. They occurred in patients in whom EC represented more than 50% of the testicular lesion. The tumour of initially conservatively managed patients did not contain an endodermal sinus component (n = 2) or presented vascular emboli (n = 1). The subjects treated by chemotherapy were characterized by the presence of emboli (n = 1) or the absence of endodermal sinus component (n = 1). The course after recurrence was favourable in 3 cases and the last patient is currently receiving chemotherapy.
EC is an independent risk factor whose presence justifies proposal of complementary treatment by retroperitoneal lymph node dissection or chemotherapy, possibly limited to 2 courses of BOE. Surveillance can only be considered in the case of a minority of EC in the tumour, in the absence of any associated risk factors.
评估伴有胚胎癌成分（EC）的睾丸I期非精原细胞瘤（NSGT）的预后及治疗方式。
1987年至1995年间，对18例伴有胚胎癌成分的睾丸I期非精原细胞瘤患者进行了治疗。15例患者的胚胎癌成分占睾丸肿瘤肿块的50%以上。4例患者中，该肿瘤情况是唯一潜在的预后因素，但14例患者中观察到血管或淋巴管栓子（n = 3）、肿瘤分期> pT1（n = 5）或无内胚窦成分（n = 9）。前3例患者接受了腹膜后淋巴结清扫术，随后的15例患者根据PVB方案[顺铂、长春花碱、博来霉素]（n = 7）或BOE方案[博来霉素、依托泊苷、顺铂]（n = 4）接受观察（n = 4）或化疗（n = 11）。
随访10至110个月（平均46个月），生存率为100%，复发率为22%。局部分期超过pT1的患者在化疗后均未复发。2例胚胎癌成分占肿瘤肿块不到50%且仅接受观察的患者未复发。4例复发患者在睾丸切除术后3至14个月（平均8.5个月）被检测到，其中2例在观察期间复发，2例在化疗后复发，需要手术切除或辅助化疗。复发发生在胚胎癌成分占睾丸病变50%以上的患者中。最初接受保守治疗的患者的肿瘤不含内胚窦成分（n = 2）或存在血管栓子（n = 1）。接受化疗的患者的特征是存在栓子（n = 1）或无内胚窦成分（n = 1）。3例复发后的病程良好，最后1例患者目前正在接受化疗。
胚胎癌是一个独立的危险因素，其存在证明通过腹膜后淋巴结清扫术或化疗进行辅助治疗是合理的，化疗可能限于2个疗程的BOE方案。仅在肿瘤中胚胎癌成分占少数且无任何相关危险因素的情况下，才可以考虑观察。
