Ondrus D, Matoska J, Belan V, Kausitz J, Goncalves F, Hornák M
Department of Urology, Comenius University Medical School, Dérer Memorial Hospital. Bratislava, Slovak Republic.
Eur Urol. 1998;33(6):562-6. doi: 10.1159/000019656.
Surveillance after orchiectomy alone becomes popular for the management of clinical stage I nonseminomatous germ cell testicular tumours (CS I NSGCTT). Effort to identify patients at high risk of relapse leads to searching prognostic factors of CS I NSGCTT. The aim of this study was to identify those patients in whom a surveillance policy is less likely to be successful.
Seventy-two CS I NSGCTT patients were stratified to different risk-adapted therapeutic approaches according to histopathologic findings of primary tumor removed by inguinal orchiectomy. Eighteen patients (group A) with vascular invasion and majority of embryonal carcinoma component in the primary tumor were treated with adjuvant BEP chemotherapy. None of them experienced disease progression after a median follow-up period of 36 months after orchiectomy. Five patients (group B) with vascular invasion and the majority of teratomatous elements in the primary tumor have been followed up 56 months after orchiectomy. They were treated with primary retroperitoneal lymph node dissection (RPLND). Two of them (40%) had pathologic stage II after RPLND and underwent subsequent chemotherapy. One of them died due to disease progression 29 months following orchiectomy. Another one lives with no evidence of disease (NED). Three patients in pathologic stage I are alive with NED. Forth-nine patients (group C) without vascular invasion have been followed up for a median duration of 37 months after orchiectomy. They were kept under close surveillance, consisted of regular follow-up with tumor markers, chest x-ray and CT of the retroperitoneum. Disease progression was observed in 7 (14.3%) patients after a median duration of 8 months after orchiectomy. They were treated with BEP chemotherapy and live with disease-free median survival of 22 months after completion of therapy. The overall survival rate of all 72 patients was 98.6%. The median survival for all patients was 37 months (range 7-73).
The authors will continue to use surveillance policy only in patients without vascular invasion in the primary tumor.
单纯睾丸切除术后监测在临床I期非精原细胞性生殖细胞睾丸肿瘤（CS I NSGCTT）的管理中变得流行起来。为识别复发高危患者，人们努力寻找CS I NSGCTT的预后因素。本研究的目的是确定那些监测策略不太可能成功的患者。
根据经腹股沟睾丸切除术切除的原发性肿瘤的组织病理学结果，将72例CS I NSGCTT患者分层至不同的风险适应性治疗方法。18例患者（A组）原发性肿瘤中有血管侵犯且主要为胚胎癌成分，接受辅助性BEP化疗。睾丸切除术后中位随访36个月，他们均未出现疾病进展。5例患者（B组）原发性肿瘤中有血管侵犯且主要为畸胎瘤成分，睾丸切除术后56个月接受随访。他们接受了原发性腹膜后淋巴结清扫术（RPLND）。其中2例（40%）RPLND术后病理分期为II期，并接受了后续化疗。其中1例在睾丸切除术后29个月因疾病进展死亡。另一例无疾病证据（NED）存活。3例病理分期为I期的患者NED存活。49例（C组）无血管侵犯的患者睾丸切除术后中位随访37个月。他们接受密切监测，包括定期随访肿瘤标志物、胸部X线和腹膜后CT。睾丸切除术后中位8个月，7例（14.3%）患者出现疾病进展。他们接受了BEP化疗，治疗完成后无病中位生存期为22个月。所有72例患者的总生存率为98.6%。所有患者的中位生存期为37个月（范围7 - 73个月）。
作者将继续仅对原发性肿瘤无血管侵犯的患者采用监测策略。
