Surveillance policy for Japanese patients with stage I testicular germ cell cancer in the multi-detector computed tomography era.
Surveillance policy for Japanese patients with stage I testicular germ cell cancer in the multi-detector computed tomography era.
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多探测器计算机断层扫描时代日本 I 期睾丸生殖细胞癌患者的监测政策。
DOI：
10.1007/s10147-015-0828-1
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Yonese J.
中科院分区：
文献类型：
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作者：
Yuasa T;Inoshita N;Tanaka H;Urakami S;Yamamoto S;Fujii Y;Masuda H;Fukui I;Ishikawa Y;Yonese J.
在多探测器计算机断层扫描（MDCT）时代，对日本临床I期睾丸生殖细胞癌（GCC）患者的监测结果进行了研究。方法回顾性分析1999年3月至2013年2月在我院治疗的92例日本期GCC患者的病历。由于6例患者要求并接受了预防性化疗，2例患者严重偏离监测计划，这些患者被排除在研究之外。结果诊断后的中位随访期为5.1年（四分位数范围：IQR， 2.3-7.7年）。84例患者中，8例（9.5%）患者在观察期内癌症复发。在组织学亚型方面，54例精原细胞瘤患者复发率为5例（9.3%），30例非精原细胞瘤性生殖细胞瘤（NSGCT）患者复发率为3例（10%）。所有8名复发的患者都在2年内复发；他们都接受了诱导化疗，在撰写本文时仍然活着，没有疾病的迹象。在31例肿瘤大于4cm并侵犯睾丸的精原细胞瘤患者中，在监测期间有3例（9.7%）复发。另一方面，在13例NSGCT伴血管侵犯的患者中，3例（23%）复发，而在11例（0%）无血管侵犯的患者中，该数字为零。结论在本研究的5年观察期内，日本一期睾丸GCC患者的复发率不到10%。隐匿性疾病复发的风险在MDCT时代可能会降低。所有患者必须充分了解预期复发率和化疗药物暴露的潜在风险。
BackgroundThe outcome of surveillance for Japanese patients with clinical stage I testicular germ cell cancer (GCC) was investigated in the multi-detector computed tomography (MDCT) era.MethodsThe medical records of 92 Japanese patients with stage I GCC, who received treatment in our institution between March 1999 and February 2013, were reviewed. As six patients requested and received prophylactic chemotherapy and two patients seriously deviated from surveillance schedule, these patients were excluded from the study. Data from a total 84 patients were analyzed,ResultsThe median follow-up period following diagnosis was 5.1 years (inter-quartile range: IQR, 2.3–7.7 years). Of the 84 patients, eight (9.5 %) had a recurrence of their cancer in this observation period. Regarding histologic subtypes, the recurrence rates were five (9.3 %) of the 54 patients with seminoma and three (10 %) of the 30 patients with nonseminomatous germ cell tumor (NSGCT). All eight patients who experienced a recurrence did so within 2 years; they all underwent induction chemotherapy and remain alive at the time of writing, with no evidence of disease. Among 31 seminoma patients with a tumor more than 4 cm in size and rete testis invasion, cancer recurred in three (9.7 %) during the surveillance period. On the other hand, among the 13 patients with NSGCT and vascular invasion, three (23 %) experienced a recurrence, whereas the figure was zero for the 11 (0 %) patients without vascular invasion.ConclusionFewer than 10 % of Japanese patients with stage I testicular GCC suffered a recurrence in the 5-year observation period of this study. The risk of occult disease, which will result in relapse, might be decreased in the MDCT era. All patients must be fully informed of the anticipated recurrence rate and the potential risks of exposure to chemotherapy agents.