Stage II testicular seminoma: Patterns of recurrence and outcome of treatment
Stage II testicular seminoma: Patterns of recurrence and outcome of treatment
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DOI：
10.1016/j.eururo.2004.01.020
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发表时间：
2004-06-01
期刊：
影响因子：
23.4
通讯作者：
Warde, PR
中科院分区：
文献类型：
--
作者：
Chung, PWM;Gospodarowicz, MK;Warde, PR
目的：回顾 II 期睾丸精原细胞瘤患者的治疗结果和失败模式，并确定复发的预后因素。方法：从 1981 年到 1999 年，126 名 II 期精原细胞瘤男性在玛格丽特公主医院接受治疗。其中，95 例接受放疗 (RT)，31 例接受化疗 (ChT)。分析患者和肿瘤特征对后续复发的预后意义。结果：中位随访 8.5 年时，5 年和 10 年总生存率为 93%，5 年和 10 年病因特异性生存率为 94%，5 年和 10 年无复发率均为 85%。接受放疗的 IIA 期和 IIB 期患者以及接受化疗的 IIB 期患者的 5 年无复发率分别为 91.7%、89.7% 和 83.3%。 17% 的放疗患者和 6% 的化疗患者出现复发。在 RT 患者中，最常见的复发部位是左锁骨上窝、肺/纵隔、骨、主动脉旁和肝脏；九名患者有单独的复发部位。两名接受化疗的患者主动脉旁和髂淋巴结复发。对于 RT 患者，较大的原发肿瘤大小与复发率降低相关。研究发现，年龄、睾丸网侵犯和淋巴管侵犯不具有预后意义。 结论：对于 IIA/B 期精原细胞瘤，放疗继续提供良好的效果，因为大多数患者仅通过这种治疗即可治愈。化疗是 IIC 期精原细胞瘤的首选治疗方法。 (C) 2004 Elsevier B.V. 保留所有权利。
Objectives: To review treatment outcome and patterns of failure for patients with stage II testicular seminoma and to identify prognostic factors for relapse.Methods: From 1981 to 1999, 126 men with stage II seminoma were treated at Princess Margaret Hospital. Of these, 95 were treated with radiotherapy (RT) and 31 with chemotherapy (ChT). Patient and tumour characteristics were analyzed for prognostic significance for subsequent relapse.Results: At median follow-up of 8.5 years, the 5- and 10-year overall survival were both 93%, the 5- and 10-year cause-specific survival were both 94% and the 5- and 10-year relapse-free rates were both 85 %. Patients with stage IIA and IIB disease treated with RT and stage IIB treated with chemotherapy had 5-year relapse-free rates of 91.7%, 89.7% and 83.3%, respectively. Seventeen percent of patients treated with radiotherapy and 6% of those treated with chemotherapy have relapsed. Of the RT patients the commonest sites of relapse were left supraclavicular fossa, lung/mediastinum, bone, para-aortics and liver; nine patients had a solitary site of relapse. Two patients treated with chemotherapy had recurrence in the para-aortic and iliac nodes. For RT patients, larger primary tumour size was associated with a reduction in relapse rate. Age, rete testis invasion and lymphovascular invasion were found not to be of prognostic significance.Conclusions: In stage IIA/B seminoma, radiotherapy continues to provide excellent results, as the majority of patients will be cured with this treatment alone. Chemotherapy is the treatment of choice for stage IIC seminoma. (C) 2004 Elsevier B.V. All rights reserved.