睾丸混合性生殖细胞肿瘤临床分析

A clinical analysis of testicular mixed germ cell tumors

目的探讨睾丸混合性生殖细胞肿瘤(TMGCT)的治疗方法及其效果。方法回顾性分析我院自2003年1月至2016年12月收治的睾丸混合性生殖细胞肿瘤患者15例,睾丸或同时存在的腹膜后肿瘤切除标本病理至少含有2种肿瘤成分;临床分期Ⅰ期8例,Ⅱ期2例,Ⅲ期5例。转移性肿瘤预后分期,2例II期肿瘤均为预后良好,5例III期肿瘤中,3例预后不良,2例预后良好。患者行根治性睾丸切除术后,根据规范和指南的方案,进行化疗或其他治疗,并密切随访。结果本组病例TMGCT占同期生殖细胞肿瘤的比例为31.3%,各种肿瘤成分组成及出现频次:卵黄囊瘤9次(60%),精原细胞瘤9次(60%),胚胎癌9次(60%),畸胎瘤6次(40%),绒癌2次(13.3%)。本组按规范和指南治疗,有较好的疗效,15例TMGCT患者,共随访2-15年(平均6.5年),死亡2例(均为DI期患者),其余均存活无复发,无进展生存率为76.7%。结论TMGCT在睾丸生殖细胞肿瘤中占一定比例,可能出现转移肿瘤和原发肿瘤的成分不一致的情况,按规范和指南治疗并注意畸胎瘤的特殊性,TMGCT可得到较好疗效。

Objective To investigate the treatment of testicular mixed germ cell tumor (TMGCT)and its effect. Methods A retrospective analysis of 15 cases of TMGCT who were treated in our hospital from January 2003 to December 2016 was performed. Testicular specimens or simultaneous retroperitoneal tumor resection specimens contained at least two types of tumor components;There were 8 cases in stage I, 2 cases in stage II and 5 cases in stage III. The prognostic-based staging of metastatic tumors: two patients with stage II tumors had good prognosis, of the 5 stage III tumors, 3 had poor prognosis and 2 had good prognosis. Patients underwent radical orchiectomy, then received chemotherapy and other treatments according to regulations and guidelines, subsequently they were followed up closely. Results The proportion of TMGCT in germ cell tumors in the same period was 31.3%. The composition and frequency of various tumors were as follows yolk sac tumor 9 times (60%),seminoma 9 times (60%), embryonal cancer 9 Times (60%), teratoma 6 times (40%),choriocarcinoma 2 times (13.3%). According to the regulations and guidelines for treatment, they had a good effect. 15 cases of TMGCT patients underwent a total of 2-15 years of follow-up (average 6.5 years), 2 died (all of patients with stage III), the rest survived without recurrence. The survival rate was 76.7%. Conclusion TMGCT accounts for a certain proportion of testicular germ cell tumors, and there may be inconsistencies in the components between metastatic tumors and primary tumors. According to the regulations and guidelines for treatment and attention to the specificity of teratomas, the patients with TMGCT can achieve good results.