小儿睾丸恶性生殖细胞瘤的回顾性分析

Retrospective analysis of the treatment of the infantile malignant germinoma of the testicles

目的 探索小儿睾丸恶性生殖细胞瘤合理的治疗方案。方法 Ⅰ期无高危因素 18例行睾丸高位切除术后密切随访 (A组 ) ;Ⅰ期有高危因素和Ⅱ期 31例分为 13例行睾丸切除加腹膜后淋巴结清扫加不规则化疗 (B组 ) ,10例行睾丸切除加腹膜后淋巴结清扫加规则化疗 (C组 ) ,8例行睾丸切除加规则化疗 (D组 )。结果 A组、B组间生存率差异有显著性意义 (P <0 .0 5 ) ,B组与C组、D组间生存率差异有显著性意义 (P <0 .0 5 ) ,C组、D组间生存率差异无显著性意义 (P >0 .0 5 )。结论 年龄小、分期早预后好 ,Ⅰ期有高危因素及Ⅱ期者应行与化疗的综合治疗 。

Objective To retrospectively review the efficacy of different treatments for the infantile malignant germinoma of the testicle at stage Ⅰand Ⅱ, and to probe the better treatment scheme.Methods 49 infants with malignant germinoma of testicles (group A, n =18, stageⅠwithout high risk factors) were treated by high positioned excision of testicle. 31 cases at stage Ⅰ with high risk factors and stage Ⅱ (group B, n =13) were treated by the excision of testicle combined with radical dissection of retroperitoneal lymph nodes and irregular chemotherapy. The group C ( n =10) were treated by the excision of testicle combined with radical dissection of retroperitoneal lymph nodes and regular chemotherapy, and group D ( n =8) were treated by the excision of testicle plus regular chemotherapy.Results The 2 year survival rate for stage Ⅰ without high risk factors was significantly higher than that for stage Ⅰwith high risk factors ( 88.9 % vs 54.5 %, P < 0.05 ). The survival rate for group A was significantly higher than that of group C and group D ( P < 0.05 ). There was no difference between group C and group D ( P > 0.05 ). The survival rate for group B were significantly lower than that of group C or group D ( P < 0.05 ). There was no difference between group C and group D ( P > 0.05 ).Conclusions The patients at younger age and earlier stage had better prognosis. These at stage Ⅰ with high risk factors or at stage Ⅱ should be treated by comprehensive scheme. The regular chemotherapy can replace radical dissection of retroperitoneal lymph nodes.