Risk of testicular cancer in cohort of boys with cryptorchidism
Risk of testicular cancer in cohort of boys with cryptorchidism
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DOI：
10.1136/bmj.314.7093.1507
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发表时间：
1997-05-24
影响因子：
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通讯作者：
Pike, MC
中科院分区：
文献类型：
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作者：
Swerdlow, AJ;Higgins, CD;Pike, MC
目的：根据病例记录的恶性肿瘤、治疗和活检细节，确定与隐睾相关的睾丸癌风险及其治疗。设计：队列研究。地点：伦敦大奥蒙德街病童医院。对象：1951- 1964年间在医院接受睾丸切除术或激素治疗的1075例隐睾男孩。主要结局指标：与普通人群中男性相比，该队列中睾丸癌的相对风险。结果：随访至1990年中期，11例患者发生12例睾丸癌（男性隐睾患者患癌的相对危险度= 7.5(95%可信区间3.9 ~ 12.8)）。相对风险显著下降超过15年后的兰花切除术后，但没有下降的年龄更年轻的兰花切除术。在睾丸切除术期间切除活检样本的睾丸的风险显著增加（相对风险= 66.7(23.9至143.3)），与普通人群中男性睾丸相比，这些睾丸的相对风险显著高于未在睾丸切除术中取活检样本的隐睾睾丸（6.7(2.7至13.5)）。在病例记录中，没有理由活检或区分活检样本后发展为恶性肿瘤的睾丸的临床方面。除了一个睾丸有发育不良的特征外，在最初的活检中没有明显的组织学异常。结论：活检似乎是睾丸癌的一个更强的危险因素比任何因素先前确定。开放性活检的创伤可能会大大增加恶性肿瘤的风险，或者根据预测恶性肿瘤的临床因素选择睾丸进行活检，但在病例说明中未提及。
Objective: To determine the risk of testicular cancer in relation to undescended testis and its treatment based on recorded details of the maldescent, treatment, and biopsy from case notes.Design: Cohort study.Setting: Hospital for Sick Children, Great Ormond Street, London.Subjects: 1075 boys with cryptorchidism treated by orchidopexy or hormones at the hospital during 1951-64.Main outcome measures: Relative risk of testicular cancer in the cohort compared with men in the general population.Results: 12 testicular cancers occurred in 11 of the patients during follow up to mid-1990 (relative risk of cancer in males with cryptorchidism = 7.5 (95% confidence interval 3.9 to 12.8)). The relative risk fell significantly beyond 15 years after orchidopexy but did not decrease with younger age at orchidopexy. Risk was significantly raised in testes that had had biopsy samples removed during orchidopexy (relative risk = 66.7 (23.9 to 143.3) compared with a testis in a man in the general population) and was significantly greater in these testes than in undescended testes that had not had biopsy samples taken at orchidopexy (6.7 (2.7 to 13.5)). No reasons for biopsy or distinguishing clinical aspects of the testes that had had biopsy samples taken and later developed malignancies were evident in the case notes. No histological abnormalities were evident at initial biopsy except in one testis that had features of dysgenesis.Conclusions: Biopsy seems to be a stronger risk factor for testicular cancer than any factor previously identified. The trauma of open biopsy may contribute substantially to risk of malignancy or the testes may have been selected for biopsy on the basis of clinical factors predictive of malignancy but not mentioned in the case notes.