基于SEER数据库分析1011例儿童睾丸非精原细胞瘤的临床病理特征及预后  

Clinical features and outcomes of testicular nonseminomatous germ cell tumor:a SEER database analysis of 1011 children

作　　者：杜勇 刘亮华 邹兵 陈志力 陈强 邓睿 杨平[1] Du Yong;Liu Lianghua;Zou Bing;Chen Zhili;Chen Qiang;Deng Rui;Yang Ping(Department of Pediatric Surgery,Central Municipal Hospital,Suining 629000,China;Department of Clinical Laboratory,Central Municipal Hospital,Suining 629000,China)

机构地区：[1]遂宁市中心医院小儿外科,遂宁629000 [2]遂宁市中心医院检验科,遂宁629000

出　　处：《中华小儿外科杂志》2024年第3期247-255,共9页Chinese Journal of Pediatric Surgery

基　　金：四川省医学科研课题计划(S20067)。

摘　　要：目的分析睾丸非精原细胞瘤(nonseminomatous germ cell tumor,NSGCT)患儿的临床病理特征及预后,探讨其预后影响因素。方法回顾性分析SEER数据库中2004年至2019年诊断为NSGCT者(年龄≤18岁)的临床资料,采用χ2检验或Fisher确切概率法对比各组患儿病例构成比,采用Kaplan-Meier法绘制生存曲线并用Log-rank法进行检验,采用单因素和多因素COX回归风险模型分析评估影响NSGCT患儿总生存期(overall survival,OS)和癌症特异性生存期(cancer-specific survival,CSS)的相关因素。结果共1011例NSGCT患儿纳入本研究,其中混合性生殖细胞肿瘤595例,卵黄囊瘤120例,胚胎性癌143例,绒毛膜癌52例,恶性畸胎瘤101例。整个队列的中位年龄为17岁(0~18岁),中位生存时间为84个月(1~191个月)。整个队列的5年OS和CSS分别为97%和97.2%;亚组生存分析显示混合性生殖细胞肿瘤、卵黄囊瘤、胚胎性癌、绒毛膜癌、恶性畸胎瘤的5年OS和CSS分别为97.2%、98.1%、100%、82.9%、97.7%和97.6%、98.1%、100%、82.9%、97.7%,其中绒毛膜癌组患儿预后最差,组间比较差异有统计学意义(P<0.05)。单因素和多因素分析结果显示TNM分期(OS:HR=3.313,P<0.001;CSS:HR=4.065,P<0.001)、肿瘤大小(OS:HR=2.124,P=0.001;CSS:HR=1.822,P=0.013)、睾丸切除术(OS:HR=0.01,P<0.001;CSS:HR=0.01,P<0.001)及淋巴结清扫(OS:HR=0.09,P=0.018;CSS:HR=0.107,P=0.028)为NSGCT患儿OS和CSS的独立影响因素。结论儿童NSGCT是较为罕见的恶性生殖细胞肿瘤,其中卵黄囊瘤预后较好,绒毛膜癌预后最差,根治性手术是所有患儿首选的治疗方式,高危患儿应选择根治性手术、腹腔淋巴结清扫和化疗的综合治疗,患儿总体预后较好。Objective To explore the clinical features,outcomes and prognostic factors of pediatric children with nonseminomatous germ cell tumor(NSGCT)based upon the SEER database.Methods The database of Surveillance,Epidemiology and End Results(SEER)was retrospectively reviewed for 1011 NSGCT children aged≤18 years from 2004 to 2019.Categorical variables were compared with chi-square or Fisher's exact test.Log-rank test with Kaplan-Meier method was applied for survival curves.Univariate and multivariate Cox regression models were employed for assessing the impact of prognostic factors on overall survival(OS)and cancer-specific survival(CSS).Results Among them,there were 595 mixed germ cell tumors,120 yolk sac tumors,143 embryonal carcinomas,52 choriocarcinomas and 101 teratomas.The median age was 17(0-18)years.During a median follow-up period of 84(1-191)months,5-year OS/CSS rate for the whole cohort was 97% and 97.2% respectively.Subgroup analysis revealed that 5-year OS and CSS rates of mixed germ cell tumor,yolk sac tumor,embryonal carcinoma,choriocarcinoma and teratoma were 97.2%,98.1%,100%,82.9%,97.7% and 97.6%,98.1%,100%,82.9%,97.7% respectively.And choriocarcinoma children had the worst prognoses(P<0.05).Univariate and multivariate analyses revealed that TNM stage(OS:HR=3.313,P<0.001;CSS:HR=4.065,P<0.001),tumor size(OS:HR=2.124,P=0.001;CSS:HR=1.822,P=0.013),radical orchiectomy(OS:HR=0.01,P<0.001;CSS:HR=0.01,P<0.001)and lymph node dissection(OS:HR=0.09,P=0.018;CSS:HR=0.107,P=0.028)were independent prognostic factors for OS and CSS.Conclusions Pediatric testicular NSGCT is a rare malignant germ cell tumor.Yolk sac tumor has a favorable prognosis while the outcomes of choriocarcinoma are the worst.Radical surgery is preferred for high-risk NSGCT children.Comprehensive treatments include radical surgery,adjuvant chemoradiotherapy and retroperitoneal lymph node dissection(RPLND).Overall outcomes are decent.

关 键 词：睾丸 非精原细胞瘤 绒毛膜癌 预后 总生存期 

分 类 号：R737.21[医药卫生—肿瘤]