Predictors of occult metastasis in clinical stage I nonseminoma: A systematic review
Predictors of occult metastasis in clinical stage I nonseminoma: A systematic review
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DOI：
10.1200/jco.2003.01.094
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发表时间：
2003-11-15
影响因子：
45.3
通讯作者：
Habbema, JDF
中科院分区：
文献类型：
--
作者：
Vergouwe, Y;Steyerberg, EW;Habbema, JDF
目的：临床I期非恶性肿瘤性睾丸生殖细胞肿瘤患者只有在存在隐匿性转移的高风险时才应接受理想的辅助治疗。我们的目的是通过对相关文献进行系统回顾来量化隐匿性转移预测因子的重要性。此外，我们回顾了已发表的多变量模型和风险适应性治疗policy.Patients和方法：我们确定了1979年至2001年之间的23篇出版物，共报告了2,587例患者。29%的患者（2,587例患者中的759例）有隐匿性转移，在腹膜后淋巴结清扫术（n = 193）或随访期间（n = 566）诊断。结果：原发肿瘤细胞血管浸润的存在有最强的效果（OR，5.2; 95%CI，4.0至6.8）。用MIB-1单克隆抗体对原发性肿瘤细胞进行免疫组织化学染色显示增殖活性是一个有希望的预测因子（OR，4.7; 95%CI，2.0至11）。在原发性肿瘤（OR，2.9; 95%CI，2.0至4.4）和肿瘤的高病理分期（OR，2.6; 95%CI，1.8至3.8）中发现胚胎癌的中间效应。原发肿瘤的大小和患者的年龄与隐匿性转移的相关性较弱，但也有统计学意义。到目前为止，多变量模型通常包括血管浸润和胚胎癌与一个或两个较弱的预测。没有发表的风险适应性治疗政策包括MIB-1 staining.Conclusion：几个强有力的预测隐匿性转移。应制定一项风险适应性治疗政策，纳入所有相关预测因素，以便辅助治疗更好地针对隐匿性转移患者。(C)2003年，美国临床肿瘤学会。
Purpose: Patients with clinical stage I nonseminomatous testicular germ cell tumor should ideally receive adjuvant therapy only when they are at high risk for occult metastasis. We aimed to quantify the importance of predictors for occult metastasis by performing a systematic review of the relevant literature. In addition, we reviewed published multivariable models and risk-adapted treatment policies.Patients and Methods: We identified 23 publications between 1979 and 2001, reporting a total of 2,587 patients. Twenty-nine percent of the patients (759 of 2,587 patients) had occult metastases, which was diagnosed either at retroperitoneal lymph node dissection (n = 193) or during follow-up (n = 566). Odds ratios (OR) were pooled using meta-analysis techniques.Results: The presence of vascular invasion of the primary tumor cells had the strongest effect (OR, 5.2; 95% Cl, 4.0 to 6.8). Immunohistochemical staining of the primary tumor cells with the MIB-1 monoclonal antibody showing proliferative activity was a promising predictor (OR, 4.7; 95% Cl, 2.0 to 11). Intermediate effects were found for embryonal carcinoma in the primary tumor (OR, 2.9; 95% Cl, 2.0 to 4.4) and a high pathologic stage of the tumor (OR, 2.6; 95% Cl, 1.8 to 3.8). Size of the primary tumor and age of the patient had weaker though also statistically significant associations with occult metastasis. Until now, multivariable models often included vascular invasion and embryonal carcinoma with one or two weaker predictors. None of the published risk-adapted treatment policies included MIB-1 staining.Conclusion: Several strong predictors for occult metastasis were identified. A risk-adapted treatment policy should be developed that incorporates all relevant predictors so that adjuvant therapy is targeted better to those with occult metastases. (C) 2003 by American Society of Clinical Oncology.