Ⅰ、Ⅱ_A/Ⅱ_B期睾丸精原细胞瘤远期疗效分析

An analysis of the long-term results of Stage Ⅰ and Ⅱ_A/Ⅱ_B testicular seminoma

目的:分析Ⅰ、ⅡA/ⅡB期单纯精原细胞瘤的远期治疗效果并探讨其治疗策略.方法:1986～2000年本院收治的Ⅰ、ⅡA/ⅡB期单纯精原细胞瘤107例,术后单纯放疗73例(68.2%),单纯化疗20例(18.7%),放、化疗联合10例(9.3%),未接受治疗4例(3.7%).复发共7例,均予以化疗,残留者辅以放疗.结果:(1)Ⅰ期与ⅡA/ⅡB期单纯放疗的总生存率(OS)及10年无瘤生存率(DFS)分别为100%(61/61)、95.1%(58/61)、100%(12/12)、100%(12/12),而单纯化疗患者分别为100%(14/14)、100%(14/14)、66.7%(4/6)、66.7%(4/6);(2)全组复发率为6.5%(7/107),再次治疗的治愈率为85.7%(6/7);(3)远期并发症发生率为2.7%(2/73).结论:(1)Ⅰ期及ⅡA/ⅡB期单纯精原细胞瘤术后可首选放疗;(2)为尽量避免放疗远期并发症,可选择部分病人行单独的腹主动脉旁野照射;(3)Ⅰ期也可单纯化疗;(4)复发病人经积极救治,仍可获较高的治愈率.

Objective：To analyze the long-term results of Stage Ⅰ and ⅡA/ⅡB testicular seminoma, and discuss the strategies of treatment. Methods ：107 cases Stage Ⅰ and ⅡA/ⅢB testicular seminoma were observed in our hospital from 1986 to 2000. All had been operated by means of orchidectomy, of which 73 cases（68.2% ） received radiotherapy only（RO） , 20（ 18.7% ） chemotherapy only（CO） , 10（9. 3% ） radiochemotherapy（RC） and 4（3.7% ） no treatment（NT）. All the 7 relapses were treated by chemotherapy, completed by radiotherapy if residual. Results：（1） The overall survival rates（OS） and 10-year disease-free-survival rates （DFS） of RO were 100% （61/61） , 95.1% （58/61） for Stage Ⅰ and 100% （12/12） , 12% （12/12） for Stage ⅡA/ⅡB, While those of CO were 100% （14/14） , 14% （14/14） and 66. 7% （4/6） , 66. 7% （4/6） , respectively. （2） The overall relapse rate was 6. 5% （7/ 107） , and a cure rate of 85.7% （6/7） was obtained after re-treated. （3） The rate of late effects was 2. 7% （ 2/73 ）. Conclusions ： （1） Radiotherapy should be considered as a standard strategy for Stage Ⅰ and ⅡA/ⅡB testicular seminoma. （2） To avoid the late effects, para-aortic irradiation only may be reasonable for some patients. （3） CO has been proved to be an effective and feasible strategy for Stage I testicular seminoma. （4） In case of relapse, a good cure rate could be achieved by a salvage treatment.