Long-term outcome of postorchiectomy surveillance for stage I testicular seminoma
Long-term outcome of postorchiectomy surveillance for stage I testicular seminoma
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DOI：
10.1016/j.ijrobp.2004.06.209
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发表时间：
2005-03-01
影响因子：
7
通讯作者：
Chander, S
中科院分区：
文献类型：
--
作者：
Choo, R;Thomas, G;Chander, S
目的：检查根治性腹股沟睾丸切除术后仅通过监测进行治疗的临床 I 期睾丸精原细胞瘤的长期结果和复发模式。方法和材料：这是一项前瞻性、单臂研究。 I 期睾丸精原细胞瘤患者按照定期、预先确定的时间表和调查进行单独监测治疗。结果：该研究在 1985 年至 1996 年间总共招募了 88 名患者。诊断时的中位年龄为 34 岁。肿瘤大小中位数为 3.5 厘米。截至 2003 年 6 月，中位随访时间为 12.1 年。仅 3 名患者失访。在 88 名患者中，71 名没有复发，17 名没有复发。 5 年、10 年和 15 年精算无复发率分别为 83%、80% 和 80%。大多数复发（17 例中有 15 例）位于膈肌下方。 17例复发患者中，14例接受放疗，3例接受联合化疗。只有我第二次复发，并通过化疗进一步挽救。所有17名复发患者在挽救治疗后均未复发。没有人死于精原细胞瘤。 Cox 比例风险模型中复发的统计学显着预测因素是睾丸网侵犯的存在（风险比 3.5，p = 0.03）。结论：保留放疗或化疗以挽救复发的监测是 I 期睾丸精原细胞瘤术后前期辅助治疗的安全替代方案。 (C) 2005 爱思唯尔公司。
Purpose: To examine the long-term outcome and patterns of relapse in clinical Stage I testicular seminoma managed with surveillance alone after radical inguinal orchiectomy.Methods and Materials: This was a prospective, single-arm study. Patients with Stage I testicular seminoma were treated with surveillance alone in accordance with regular, predefined, schedules and investigations.Results: The study accrued a total of 88 patients between 1985 and 1996. The median age at diagnosis was 34 years. The median tumor size was 3.5 cm. The median follow-up as of June 2003 was 12.1 years. Only 3 patients were lost to follow-up. Of the 88 patients, 71 remained free of relapse and 17 did not. The actuarial relapse-free rate was 83%, 80%, and 80% at 5, 10, and 15 years, respectively. Most relapses (15 of 17) were below the diaphragm. Of the 17 patients with relapse, 14 were treated with radiotherapy and 3 with combination chemotherapy. Only I had a second relapse and was further salvaged by chemotherapy. All 17 relapsed patients remained free of recurrence after salvage treatment. None died of seminoma. The statistically significant predictive factor for relapse on the Cox proportional hazards model was the presence of rete testis invasion (hazard ratio 3.5, p = 0.03).Conclusion: Surveillance with the reservation of radiotherapy or chemotherapy for salvage of relapse is a safe alternative to upfront postoperative adjuvant therapy for Stage I testicular seminoma. (C) 2005 Elsevier Inc.