基于SEER数据库分析男性睾丸卵黄囊瘤患者的临床特征及预后

Clinical features and prognosis in patients with testicular yolk sac tumor:a SEER Database analysis

目的:基于美国监测、流行病学和结局数据库(SEER数据库)分析男性睾丸卵黄囊瘤(TYST)患者的临床特征、预后及影响因素。方法:使用SEER数据库收集2000—2018年诊断为TYST的患者作为研究对象,根据患者年龄分为儿童组(≤18岁)和成人组(>18岁),采用卡方检验对比两组患者病例构成比,采用Kaplan-Meier法绘制生存曲线并用log-rank法进行检验,采用单因素和多因素Cox回归模型分析其预后影响因素。结果:共503例TYST患者纳入本研究,其中儿童组166例,成人组337例,儿童和成人组TYST患者的3、5、10年总生存率(overall survival,OS)分别为97.3%、96.3%、93.0%和84.9%、82.3%、78.9%。儿童组单纯手术治疗者5年OS优于手术联合化疗者(98.8%vs 92.2%,P=0.02);成人组单纯手术治疗者(96.3%)5年OS优于手术联合化疗者(78.6%),也优于单纯化疗者(45.9%)(均P<0.001)。单因素和多因素分析结果显示行淋巴结清扫(HR=0.086,95%CI:0.012-0.625,P=0.015)为所有患者的预后良好因素;淋巴血管侵犯(HR=11.924,95%CI:1.537-92.497,P=0.018)和SEER分期位于远处转移(HR=12.374,95%CI:6.199-24.700,P<0.001)为预后不良因素。结论:TYST是极为罕见的恶性肿瘤,预后不佳。儿童与成人患者在一般临床特征、治疗及预后方面有较大差异。淋巴结清扫、SEER分期及淋巴血管侵犯是TYST重要的预后独立影响因素。

Objective:To investigate the clinical features,prognosis,and prognostic factors of patients with testicular yolk sac tumor(TYST) based upon the database of National Cancer Institute's Surveillance,Epidemiology,and End Results(SEER).Methods:Patients diagnosed as TYST from 2000 to 2018 were extracted from the SEER database.Patients were divided into an adult(18 years) and pediatric(≤18 years) cohort for comparison.Chi-squared tests were used to examine the categorical variables between the two groups.Survival analysis was assessed by the Kaplan-Meier methods,and the differences between survival curves were analyzed using the log-rank test.Univariate and multivariate Cox regression analyses were used to evaluate prognostic factors.Results:A total of 503 cases were included in the study(166 children,337 adults).The overall 3-,5-and 10-year survival rates of pediatric patients were 97.3%、96.3%、93.0%,respectively;The overall 3-,5-and 10-year survival rates of adult patients were 84.9%、82.3%、78.9%,respectively.Pediatric patients with surgery had a significantly better survival than those with surgery plus chemotherapy(5-year OS:98.8% vs 92.2%,P=0.02).Adult patients with surgery had a significantly better survival than those with surgery plus chemotherapy and chemotherapy only(5-year OS:96.3% vs 78.6%,96.3% vs 45.9%,all P0.001).The results of the univariate and multivariate Cox regression analysis indicated that lymph node dissection was good prognostic factors(HR=0.086,95%CI:0.012-0.625,P=0.015),while lymphovascular invasion(HR=11.924,95%CI:1.537-92.497,P=0.018) and distant metastasis(HR=12.374,95%CI:6.199-24.700,P0.001) were poor prognostic factors for TYST patients.Conclusion:TYST is an extremely rare malignancy with poor prognosis.The clinicopathological characteristics,outcomes and prognostic factors differed among pediatric patients compared to adult patients.Lymph node dissection,SEER stage and lymphovascular invasion are important independent prognostic factors for TYST patients.