转移性睾丸生殖细胞肿瘤的化疗效果观察(附20例报告)  

Clinical effect of the chemotherapy of metastatic testicular germ cell tumor (with a report of 20 cases)

作　　者：张忠云[1] 孙忠全[1] 钱伟庆[1] 张正望[1] 宋建达[1] 

机构地区：[1]复旦大学附属华东医院泌尿外科,上海200040

出　　处：《临床泌尿外科杂志》2016年第8期718-722,共5页Journal of Clinical Urology

摘　　要：目的：观察转移性睾丸生殖细胞肿瘤化疗的效果。方法：回顾性分析我院2003年1月~2013年10月收治的转移性睾丸生殖细胞肿瘤患者20例,包括精原细胞瘤8例,非精原细胞瘤12例,其中畸胎瘤2例、胚胎癌3例、混合性生殖细胞肿瘤7例;临床分期Ⅱa期1例,Ⅱb期3例,Ⅱc期5例,Ⅲ期11例。患者行根治性睾丸切除术后,进行准确分期,根据指南的方案,进行化疗及其他治疗,并密切随访。结果：2例行腹膜后淋巴结清扫术及BEP方案化疗,随访5~10年,肿瘤无进展。18例行BEP/EP方案化疗,15例化疗后缓解,随访2~12年（中位数6年）,肿瘤无进展,3例化疗后瘤标一度下降之后上升,其中1例大剂量化疗＋自体造血干细胞移植后缓解,1例大剂量化疗＋自体造血干细胞移植后死亡,1例局部治疗（HIFU）后死亡。故20例患者,随访2~12年（中位数6年）,死亡2例（10%）,其余患者（90%）均未进展。结论：转移性睾丸生殖细胞肿瘤,在根治性睾丸切除术后准确分期,按指南推荐方案化疗（BEP/EP方案为主）,可取得较好效果。Objective：To evaluate the chemotherapy effect of metastatic testicular germ cell tumor.Method：The clinical and followup data of 20 cases of metastatic testicular germ cell tumor from Jan 2003 to Oct 2013 were retrospectively studied.There were eight cases of seminoma,twelve cases of nonseminoma（two cases of teratoma,three cases of embryonal carcinoma,and seven cases of mixed germ cell tumor）.According to the clinical staging of testicular cancer,we diagnosed one case of PhaseⅡa,three cases of PhaseⅡb,five cases of PhaseⅡc,eleven cases of PhaseⅢafter orchiectomy.And we treated them mainly with chemotherapy and other therapies based on the Guidelines on Testicular Cancer.And we also followed up based on the Guidelines.Result：Two cases of PhaseⅡ nonseminoma received chemotherapy of BEP regimen and RPLND,they did not relapse during followup of 5-10 years.Eighteen cases received chemotherapy of BEP/EP regimen,fifteen cases got relieved during followup of 2-12（median 6）years.Three cases did not got relieved.One case got relieved after High-Dose Chemotherapy plus Stem Cell Transplantation,one case died after High-Dose Chemotherapy plus Stem Cell Transplantation,the last case died after local treatment（HIFU）.So all twenty cases,two（10%）cases died,eighteen（90%）cases got relieved during 2-12（median 6）years followup.Conclusion：Metastatic testicular germ cell tumor should be correctly staged after orchiectomy.We treat them mainly with chemotherapy（BEP/EP regimen）based on the Guidelines on Testicular Cancer and get good effect.

关 键 词：睾丸肿瘤 转移性 化疗 

分 类 号：R737.21[医药卫生—肿瘤]