CAJ | 학술논문

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=o.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(x2=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.
목적 평고저위림상Ⅰ기고환비정원생식세포류(NSGCT)환자적엄밀수방보수치료여복막후림파결청소술(RPLND)치료적효과,이탐토위험인자용우림상Ⅰ기NSGCT예후판단적가행성.방법 회고성분석호남성종류의원、중남대학상아삼의원화호남성인민의원2001년2월지2012년4월수치적71례림상Ⅰ기NSGCT환자적림상자료,배제혈관림파관침윤、배태암성분＞암종성분50％급근치성고환절제술후종류표지물수평(AFP화/혹β-HCG)잉지속불강심지증고자,최종장46례저위환자납입연구조.근거근치성고환절제술후채용적치료방법분위엄밀수방조(30례)화RPLND치료조(16례).대가능영향환자예후적2항림상지표(배태암성분、년령)진행분석,Kaplan-Meier법비교술후무류생존솔.결과 46례환자중5례실방,41례획수방,수방솔위89％.평균수방시간61개월(15～ 147개월),기중엄밀수방조평균수방58개월(19～ 147개월),RPLND조평균수방65개월(15～ 144개월).엄밀수방조화RPLND치료조생존솔균위100％;량조환자술후1년무류생존솔분별위89％(24/27)화86％(12/14),조간비교차이무통계학의의(x 2=0.08,P=0.78).함소량배태암성분(배태암성분＜50％)적혼합성종류환자무류생존솔위83％,불함배태암성분환자위92％,조간비교차이무통계학의의(x 2=1.07,P=o.30).＜15세조여≥15세조환자술후1년무류생존솔비교차이역무통계학의의(x2=1.59,P=0.21).결론 저위림상Ⅰ기NSGCT환자엄밀수방보수치료여RPLND치료적효과무명현차이.저위환자근치성고환절제술후엄밀수방가획득이상적예후효과.
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 (x2=1.07,P=0.30).Also there was no significant difference between the patients less than 15 years and patients more than 15 years (x2=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 NSGCT may achieve satisfactory prognosis with surveillance after radical orchiectomy.