腹腔隐睾精原细胞瘤的临床特征、分期和治疗探讨

PRIMARY ABDOMINAL CRYPTORCHID SEMINOMA:ITS CLINICAL CHARACTERISTICS,STAGING AND TREATMENT RESULTS

我院１９５８年６月至１９９１年１２月收治６８例腹腔隐睾精原细胞瘤，占睾丸精原细胞瘤的１４％。６０例根据本院提出的分期标准进行分期，Ⅰ期３４例，ⅡＡ期６例，ⅢＢ期１１例，Ⅲ期５例，Ⅳ期４例。８例外院治疗后复发的病人未分期。放射治疗是主要治疗手段，少数合并或单用Ｎ－甲基溶肉瘤素化疗。全组５年、１０年生存率分别为８９．１％和８３．２％。Ⅰ期和ⅡＡ期５年、１０年生存率为１００％，ⅡＢ期分别为９０％和７７．１％，Ⅲ、Ⅳ期为５１．８％和３８．９％。原发灶大小、外侵程度、手术是否切净和预后无关。临床分期是影响预后的重要因素，各分期间生存率有显著差别。Ⅰ期和ⅡＡ期建议作腹主动脉、同侧髂血管淋巴引流区和原发肿瘤床照射，不必全腹照射。Ⅲ、Ⅳ期应以联合化疗为主。

AbstractSixty-eight patients with abdominal cryptorchid seminoma wcre treated fromJune 1958 to December 1991, accounting for 14%of patients with tcsticular semino-ma. Sixty patients were rctrospectively staged according to the system employedat our hospital and eight unstaged because of the previous treatment elsewhere。There were 34 stage Ⅰ, 6 stage Ⅱ A, 11 stage Ⅱ B, 5 stage Ⅲand 4 stage Ⅳ patie-nts. Most of patients were treated primarily with radiotherary alone,only a fewwere treated by combination with chemotherapy or chemotherapy alone,The overa-11 5-year and 10-year survivals were 100% for stages Ⅰ and Ⅱ A, 90%and 77.1%for stage Ⅱ B,51.8%and 38.9%for stages Ⅲand Ⅳ. The differences between sta-ge Ⅰ and Ⅱ, stage Ⅱ andⅢ/Ⅳ were statistically significant(P<0.05).The sizeof primary tumor, extent of invasion to adjacent organ and tissue did not influe-nce the treatment results, It is suggested that stage Ⅰ and Ⅱ A patients be treatedby radiation alone with the radiation fields covering the para-aortic nodes, ipsila-teral pelvic node chains and the primary tumor/tun1or bed, stages Ⅲ and Ⅳ betreated by radiotherapy combined with chemotherapy.