Primary chemotherapy for clinical stage II nonseminomatous germ cell tumors of the testis: a follow-up of 50 patients.
Primary chemotherapy for clinical stage II nonseminomatous germ cell tumors of the testis: a follow-up of 50 patients.
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临床 II 期睾丸非精原细胞瘤的初次化疗：对 50 名患者的随访。
DOI：
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发表时间：
1987
影响因子：
45.3
通讯作者：
M. Samuels
中科院分区：
文献类型：
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作者：
C. Logothetis;D. Swanson;F. Dexeus;C. Chong;S. Ogden;A. Ayala;A. C. Eschenbach;Douglas E. Johnson;M. Samuels
对50例临床II期睾丸非腺瘤性生殖细胞肿瘤（NSGCTT）患者进行了原发性化疗，然后在选定的患者中进行腹膜后淋巴结清扫术（RPLND）。研究人群包括34例腹膜后肿块和血清生物标志物（甲胎蛋白[AFP]和β-人绒毛膜促性腺激素[BHCG]）水平升高的患者，5例针吸活检证实腹膜后转移但生物标志物水平正常的患者，11例血清生物标志物水平升高但无腹膜后转移的放射学证据的患者。48例患者（96%）达到完全缓解（CR），平均无病生存期为132周（范围：55 - 273周）。2例患者出现疾病复发。1例死亡，1例在进一步治疗（48 +周）后获得第二次CR。11例患者（22%）需要化疗后RPLND。胚胎癌患者的RPLND发生率（8%）低于原发肿瘤中有畸胎瘤成分的患者[36%，P = 0.014]。为了减少双重治疗（手术+/-化疗）的频率，我们提出了个体化治疗。临床II期睾丸胚胎癌患者应接受原发性化疗。患有临床II期NSGCTT和原发肿瘤中的畸胎瘤成分的患者继续需要RPLND。中等体积病变（最大直径大于2 cm，小于或等于5 cm）的患者可仅接受RPLND治疗。畸胎瘤体积较大（最大直径大于5 cm小于或等于10 cm）的患者可能需要化疗和手术联合治疗。
Fifty patients with clinical stage II nonseminomatous germ cell tumor of the testis (NSGCTT) were treated with primary chemotherapy followed by a retroperitoneal lymph node dissection (RPLND) in selected patients. The study population included 34 patients with retroperitoneal masses and elevated levels of serum biomarkers (alpha-fetoprotein [AFP] and beta-human chorionic gonadotropin [BHCG] ), five with needle aspiration biopsy-proven retroperitoneal metastases but normal levels of biomarkers, and 11 in whom there were rising levels of serum biomarkers but no radiographic evidence of retroperitoneal metastases. Forty-eight patients (96%) achieved a complete response (CR), with a mean disease-free survival of 132 weeks (range, 55 to 273 weeks). Two patients developed recurrent disease. One died and one achieved a second CR with further therapy (48 + weeks). Postchemotherapy RPLND was required in 11 patients (22%). Patients with embryonal carcinoma had a lower frequency of RPLND (8%) than patients with teratomatous elements in their primary tumor [36%, P = .014]. To reduce the frequency of double therapy (surgery +/- chemotherapy), we propose individualized therapy. Patients presenting with clinical stage II embryonal carcinoma of the testis should receive primary chemotherapy. Patients with clinical stage II NSGCTT and teratomatous elements in their primary tumor continue to require an RPLND. Those patients with intermediate volume disease (greater than 2 cm less than or equal to 5 cm in maximum diameter) may be treated with an RPLND only. Patients with higher volume teratomatous elements (greater than 5 cm less than or equal to 10 cm in maximum diameter) are likely to require the combination of chemotherapy and surgery.