Stage I non-seminomatous germ-cell tumours of the testis:: identification of a subgroup of patients with a very low risk of relapse
Stage I non-seminomatous germ-cell tumours of the testis:: identification of a subgroup of patients with a very low risk of relapse
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DOI：
10.1016/s0959-8049(00)00442-1
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发表时间：
2001-03-01
影响因子：
8.4
通讯作者：
Terrier-Lacombe, MJ
中科院分区：
文献类型：
--
作者：
Alexandre, J;Fizazi, K;Terrier-Lacombe, MJ
对于能够区分具有高复发风险和低复发风险的临床 I 期非精原性生殖细胞肿瘤 (NSGCT) 的可重复预后模型尚未达成共识。本研究的目的是评估睾丸切除术后接受监测的 1 期 NSGCT 患者组织学参数的预后价值。我们回顾性评估了 1984 年至 1996 年间在我们机构接受监测的 88 名连续 I 期 NSGCT 患者的肿瘤标本。24 名患者复发 (27%)。多变量分析指出血管侵犯 (VI)（相对风险 (RR) = 3.8：95% 置信区间 (CI) 1.4-10.4）和成熟畸胎瘤的存在（RR = 0.2：95% CI 0.1-0.6）与无复发生存 (RFS) 独立相关。患者可相应地分为三个低预后组（27 名患有成熟畸胎瘤但无 VI 的患者）。中度复发风险（34 名患者同时患有 VI 和成熟畸胎瘤，或者既没有 VI 也没有成熟畸胎瘤）和高复发风险（23 名患者患有 VI，但没有成熟畸胎瘤）。这三组的复发率分别为 0%、29% (95% CI: 23-35%) 和 61% (95% CI: 55-67%)。该预后指数基于两个标准病理参数，确定了复发风险极低的亚组，约占 I 期患者的三分之一。属于该亚组的患者应仅通过监测进行管理。代替腹膜后淋巴结清扫术（RPLND）或辅助化疗。 (C) 2001 Elsevier Science Ltd. 保留所有权利。
There is no consensus about a reproducible prognostic model capable of distinguishing between clinical stage I non-seminomatous germ cell tumour (NSGCT) carrying a high and low risk of relapse. The aim of this study was to assess the prognostic value of histological parameters in patients with stage 1 NSGCT undergoing surveillance after orchiectomy. We retrospectively evaluated tumour specimens from 88 consecutive stage I NSGCT patient undergoing surveillance in our institution between 1984 and 1996. 24 patients relapsed (27%). Multivariate analysis singled out vessel invasion (VI) (relative risk (RR) = 3.8: 95% confidence interval (CI) 1.4-10.4) and thr presence of mature teratoma (RR = 0.2: 95% CI 0.1-0.6) us independently correlated with relapse-free survival (RFS). Patients can be classified accordingly into three prognostic groups with a low (27 patients with mature teratoma but without VI). intermediate (34 patients with both VI and mature teratoma or with neither VI or mature teratoma) and a high risk (23 patients with VI, but without mature teratoma) of relapse. Relapse rates in these three groups were 0%, 29% (95% CI: 23-35%) and 61% (95% CI: 55-67%), respectively. This prognostic index, based on two standard pathological parameters, identified a subgroup with a very low risk of relapse that represents approximately one third of stage I patients. Patients who belong to this subgroup should be managed by surveillance only. instead of retroperitoneal lymph node dissection (RPLND) or adjuvant chemotherapy. (C) 2001 Elsevier Science Ltd. All rights reserved.