低危临床Ⅰ期睾丸非精原生殖细胞瘤患者不同治疗方法的疗效比较  

Efficacy analysis of different therapeutic methods in low-risk patients with clinical stage Ⅰ nonseminomatous germ cell testicular tumors

作　　者：范刚[1] 谢宇[1] 韩惟青[1] 蒋志强[2] 杨科[3] 曾福华[1] 裴夏明[1] 

机构地区：[1]中南大学湘雅医学院附属肿瘤医院湖南省肿瘤医院泌尿外科,长沙410013 [2]中南大学湘雅三医院泌尿外科 [3]湖南省人民医院泌尿外科

出　　处：《中华泌尿外科杂志》2014年第8期611-615,共5页Chinese Journal of Urology

摘　　要：目的 评估低危临床Ⅰ期睾丸非精原生殖细胞瘤（NSGCT）患者的严密随访保守治疗与腹膜后淋巴结清扫术（RPLND）治疗的效果,以探讨危险因子用于临床Ⅰ期NSGCT预后判断的可行性.方法 回顾性分析湖南省肿瘤医院、中南大学湘雅三医院和湖南省人民医院2001年2月至2012年4月收治的71例临床Ⅰ期NSGCT患者的临床资料,排除血管淋巴管浸润、胚胎癌成分＞癌肿成分50％及根治性睾丸切除术后肿瘤标志物水平（AFP和/或β-HCG）仍持续不降甚至增高者,最终将46例低危患者纳入研究组.根据根治性睾丸切除术后采用的治疗方法分为严密随访组（30例）和RPLND治疗组（16例）.对可能影响患者预后的2项临床指标（胚胎癌成分、年龄）进行分析,Kaplan-Meier法比较术后无瘤生存率.结果 46例患者中5例失访,41例获随访,随访率为89％.平均随访时间61个月（15～ 147个月）,其中严密随访组平均随访58个月（19～ 147个月）,RPLND组平均随访65个月（15～ 144个月）.严密随访组和RPLND治疗组生存率均为100％;两组患者术后1年无瘤生存率分别为89％（24/27）和86％（12/14）,组间比较差异无统计学意义（x^2=0.08,P=0.78）.含少量胚胎癌成分（胚胎癌成分＜50％）的混合性肿瘤患者无瘤生存率为83％,不含胚胎癌成分患者为92％,组间比较差异无统计学意义（x^2=1.07,P=0.30）.＜15岁组与≥15岁组患者术后1年无瘤生存率比较差异亦无统计学意义（x^2=1.59,P=0.21）.结论 低危临床Ⅰ期NSGCT患者严密随访保守治疗与RPLND治疗的效果无明显差异.低危患者根治性睾丸切除术后严密随访可获得理想的预后效果.Objective To evaluate the effects of rigorous surveillance and retroperitoneal lymph node dissection （RPLND） in the treatment of low-risk patients with clinical stage Ⅰ nonseminomatous germ cell testicular tumors （NSGCT） after radical orchiectomy.Methods The data of 71 patients with clinical stage Ⅰ NSGCT were analyzed retrospectively in Hunan Provincial Tumor Hospital,Xiangya Third Hospital of Central South University and Hunan Provincial People＇s Hospital between Feb,2001 and Apr,2012.Excluding lymphatic and vascular invasion,percentage of embryonal carcinoma〉50% and increasing tumour markers （AFP/β-HCG） following orchiectomy,46 low-risk patients out of 71 patients with clinical stage Ⅰ NSGCT were selected and divided into rigorous surveillance group （30 cases） and RPLND group （16 cases） according to different therapeutic methods after radical orchiectomy.Univariate analysis was used to confirm variables associated with disease progression,and the disease free survival rates （DFSR） were compared by using Kaplan-Meier analysis.Results Five cases were lost,and 41 cases were followed up for an average of 61 months （range,15-147 months）,with 58 months in rigorous surveillance group （range,19-147months） and 65 months in RPLND group （range,15-144 months）.The survival rate was 100% in 2 groups.The DFSR was 89% （24/27） and 86% （12/14）,respectively,and there was no significant difference between the 2 groups （x2 =0.08,P=0.78）.The DFSR was 83% in patients with small amout of embryonal （percentage of embryonal carcinoma 〈 50%）,and 92% in patients without embryonal carcinoma,and there was no significant difference between the 2 groups （x^2=1.07,P=0.30）.Also there was no significant difference between the patients less than 15 years and patients more than 15 years （x^2=1.59,P =0.21）.Conclusions There is no significant difference in recurrence rate and DFSR between rigorous surveillance group and RPLND group.Low-risk patients with clinical stage Ⅰ NSG

关 键 词：非精原生殖细胞瘤 睾丸肿瘤 随访 危险因素 年龄因素 

分 类 号：R737.21[医药卫生—肿瘤]