A MULTIDISCIPLINARY APPROACH TO PRIMARY NONSEMINOMATOUS GERM-CELL TUMORS OF THE MEDIASTINUM
A MULTIDISCIPLINARY APPROACH TO PRIMARY NONSEMINOMATOUS GERM-CELL TUMORS OF THE MEDIASTINUM
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DOI：
10.1016/s0003-4975(10)62138-8
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发表时间：
1987-12-01
影响因子：
4.6
通讯作者：
GOLDSTRAW, P
中科院分区：
文献类型：
--
作者：
KAY, PH;WELLS, FC;GOLDSTRAW, P
基于顺铂的化疗的引入显着改善了纵隔原发性非精原细胞生殖细胞肿瘤患者的预后。自 1978 年以来，已有 12 名男性患者（平均年龄 29 岁）出现较大纵隔肿块、正常睾丸和异常睾丸肿瘤标志物。 11 名患者的甲胎蛋白水平升高（中位数 1,300 μg/L；正常，低于 10 μg/L），3 名患者的人绒毛膜促性腺激素 β 部分水平升高（中位数，8,000 IU/L；正常，低于 5 IU/L）。两名患者接受了初次手术干预和化疗。 10 名患者接受了主要化疗（顺铂、硫酸长春碱或依托泊苷和硫酸博莱霉素），随后对 7 名患者进行了肿瘤肿块的定时手术切除。六名 (60%) 患者对主要化疗有反应，肿瘤标志物正常化。本组术后死亡 1 例，复发 1 例。剩下的 4 名患者平均存活五年，没有患病。 4例肿瘤标志物持续升高的患者中，2例在6个月内死亡，1例存活并复发，1例在三个月后失访。顺铂化疗后肿瘤标志物恢复正常的患者在根治性手术后具有良好的长期预后。如果肿瘤标志物持续升高，则预后较差。
The introduction of cis-platinum-based chemotherapy has dramatically improved the prognosis for patients with primary nonseminomatous germ cell tumors of the mediastinum. Since 1978, 12 male patients (mean age, 29 years) have been seen with a large mediastinal mass, normal testes, and abnormal testicular tumor markers. Eleven patients had raised .alpha.-fetoprotein levels (median 1,300 .mu.g/L; normal, less than 10 .mu.g/L), and 3 had elevated levels of the beta fraction of human chorionic gonadotropin (median, 8,000 IU/L; normal, less than 5 IU/L). Two patients were treated by primary surgical intervention followed by chemotherapy. Ten patients were treated with primary chemotherapy (cis-platinum, vinblastine sulfate or etoposide, and bleomycin sulfate), and this was followed by timed surgical excision of the tumor mass in 7. Six (60%) patients responded to primary chemotherapy with normalization of tumor markers. In this group there was 1 postoperative death and 1 recurrence. The 4 remaining patients are alive and free from disease at a mean of five years. Of the 4 patients with persistently elevated tumor markers, 2 died within six months, 1 is alive with recurrence, and 1 is lost to follow-up at three months. Patients whose tumor markers return to normal after cis-platinum-based chemotherapy have a good long-term prognosis following radical surgery. If the tumor markers remain elevated, the prognosis is poor.