Orchiectomy alone in clinical stage I nonseminomatous testis cancer: a critical appraisal.
Orchiectomy alone in clinical stage I nonseminomatous testis cancer: a critical appraisal.
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仅睾丸切除术治疗临床 I 期非精原细胞性睾丸癌：一项重要评估。
DOI：
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发表时间：
1986
影响因子：
45.3
通讯作者：
R. Musumeci
中科院分区：
文献类型：
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作者：
G. Pizzocaro;F. Zanoni;A. Milani;R. Salvioni;L. Piva;S. Pilotti;E. Bombardieri;J. D. Tesoro;R. Musumeci
连续62例临床I期非恶性肿瘤性睾丸癌患者进入一项前瞻性研究，在睾丸切除术后不接受任何治疗，直到出现复发性疾病的临床证据。在59例可评价病例中，41例（69.5%）在中位持续时间30个月（范围，18至46个月）内持续无病，18例（30.5%）在睾丸切除术后2至36个月出现转移性疾病证据。复发患者的中位无病期为6个月。10例患者发生腹膜后转移; 7例患者发生肺转移，1例患者血清甲胎蛋白水平进行性升高。患有胚胎癌、浸润性睾丸癌（pT大于1）、瘤周血管浸润或接受经阴囊活检的患者的复发率明显更高。1例复发患者拒绝挽救治疗，死亡。其余17例患者已通过顺铂联合化疗和/或手术获得无病缓解。然而，两名患者显示进一步复发，其中一个在肺，另一个也在腹膜后淋巴结。我们认为，睾丸切除术后的监测将为临床I期非恶性肿瘤性睾丸癌提供有用的信息，但这是一项困难的研究。目前，它应仅限于专门中心。同时，腹膜后淋巴结切除术仍然是标准治疗方法。
Sixty-two consecutive patients with clinical stage I nonseminomatous testicular cancer were entered into a prospective study to receive no treatment after orchiectomy until clinical evidence of recurrent disease. Of 59 evaluable cases, 41 (69.5%) remained continuously disease free for a median duration of 30 months (range, 18 to 46 months), and evidence of metastatic disease developed in 18 patients (30.5%) from 2 to 36 months after orchiectomy. The median disease-free interval for relapsing patients was 6 months. Retroperitoneal metastases developed in ten patients; seven patients had pulmonary metastases, and one patient had progressive elevation of the serum alpha-fetoprotein level. Relapses were significantly more frequent in patients with either embryonal carcinoma, infiltrating testicular cancer (pT greater than 1), peritumoral vascular invasion, or in those who underwent transscrotal biopsy. One patient with relapse refused salvage therapy and died. The remaining 17 patients have been rendered disease free with cisplatin combination chemotherapy and/or surgery. However, two patients showed further recurrence, with one in the lung and the other one also in the retroperitoneal nodes. In our opinion, surveillance following orchiectomy will provide useful information in clinical stage I nonseminomatous testicular cancer, but it is a difficult study. For the time being, it should be restricted to specialized centers only. In the meanwhile, retroperitoneal lymphadenectomy remains the standard treatment.