Steyerberg E W, Gerl A, Fossá S D, Sleijfer D T, de Wit R, Kirkels W J, Schmeller N, Clemm C, Habbema J D, Keizer H J
Department of Medical Oncology, University Hospital Groningen, The Netherlands.
J Clin Oncol. 1998 Jan;16(1):269-74. doi: 10.1200/JCO.1998.16.1.269.
To validate predictions of the histology (necrosis, mature teratoma, or cancer) of residual retroperitoneal masses in patients treated with chemotherapy for metastatic nonseminomatous testicular germ cell tumor.
We studied 172 testicular cancer patients who underwent resection while tumor markers were normal. Predictive characteristics for the residual histology were registered, including the presence of teratoma elements in the primary tumor, the prechemotherapy level of tumor markers (alpha-fetaprotein [AFP], human chorionic gonadotropin [HCG], lactate dehydrogenase [LDH]), the size of the residual mass, and the percentage of shrinkage in mass diameter. We calculated the predicted probability of necrosis and the ratio of cancer and mature teratoma with previously published logistic regression formulas.
The distribution of the residual histology was necrosis in 77 (45%), mature teratoma in 72 (42%), and cancer in 23 (13%). Necrosis could be well distinguished from other tissue, with an area under the receiver operating characteristic (ROC) curve of 82%. No tumor was found in 15 patients with a predicted probability of necrosis over 90%. The predicted probabilities corresponded reliably with the observed probabilities (goodness-of-fit tests, P > .20), although a somewhat higher probability of necrosis was observed in patients treated with chemotherapy containing etoposide. Conversely, cancer could not reliably be predicted or adequately discriminated from mature teratoma.
The predicted probabilities of necrosis have adequate reliability and discriminative power. These predictions may validly support the decision-making process regarding the need and extent of retroperitoneal lymph node dissection.
验证转移性非精原细胞瘤性睾丸生殖细胞肿瘤化疗患者残留腹膜后肿块组织学（坏死、成熟畸胎瘤或癌）的预测结果。
我们研究了172例睾丸癌患者，这些患者在肿瘤标志物正常时接受了切除术。记录残留组织学的预测特征，包括原发肿瘤中畸胎瘤成分的存在、化疗前肿瘤标志物（甲胎蛋白[AFP]、人绒毛膜促性腺激素[HCG]、乳酸脱氢酶[LDH]）水平、残留肿块大小以及肿块直径缩小百分比。我们使用先前发表的逻辑回归公式计算坏死的预测概率以及癌与成熟畸胎瘤的比例。
残留组织学分布为坏死77例（45%）、成熟畸胎瘤72例（42%）、癌23例（13%）。坏死可与其他组织很好地区分，受试者工作特征（ROC）曲线下面积为82%。15例预测坏死概率超过90%的患者未发现肿瘤。预测概率与观察到的概率可靠对应（拟合优度检验，P>.20），尽管在接受含依托泊苷化疗的患者中观察到坏死概率略高。相反，癌无法可靠预测，也无法与成熟畸胎瘤充分区分。
坏死的预测概率具有足够的可靠性和鉴别力。这些预测可能有效地支持关于腹膜后淋巴结清扫的必要性和范围的决策过程。
