ASCO2013：Ⅰ期精原细胞瘤生存率高

　　对于绝大多数成功接受了睾丸切除术的Ⅰ期精原细胞瘤患者而言，接受术后监测就足够了。这是迄今针对此类患者的最大规模研究的结果。

　　哥本哈根大学医院的Mette SaskΦ Mortensen博士在美国临床肿瘤学会(ASCO)2013年会前的新闻发布会上报告，仅接受监测随访的1,822名丹麦男性患者具有极高的疾病特异性生存率——99.5%。

　　ASCO候任主席、纽约纪念Sloan-Kettering 癌症中心乳腺癌医疗部主任Clifford Hudis博士指出，上述结果意味着，每1,000例接受监测随访的患者在10年内只会发生4例死亡。他称这项研究与近期另外数项研究一样，提示在患者诊疗中“做的越少效果越好(less is more)”，监测随访可使患者免受化疗、放疗副作用的伤害，同时又不会损害长期生存率。

　　精原细胞瘤是一种相对罕见的癌症，但却是年轻男性中的最常见实体肿瘤。初始治疗通常为睾丸切除术，但尚无明确的术后管理策略可供遵循。本项研究的结果可能会使美国的临床医生更倾向于监测随访。美国大约50%的精原细胞瘤患者在术后接受放疗或卡铂化疗。

　　总体上，355例患者(19.5%)在监测随访期间出现了复发。至复发的中位时间为13.7个月，多数患者(72.4%)是在头2年内复发的。另有20.3%的患者在第2~5年期间复发，其余7.3%在5年后复发。Mortensen博士指出：“除了这19.5%的复发患者，其余80%的患者通过监测随访得以在睾丸切除术后避免不必要的治疗。对于Ⅰ期精原细胞瘤患者而言，监测是一种安全的策略。”

　　自1984年以来，监测一直是丹麦Ⅰ期精原细胞瘤的主要随访策略，包括为期5年的定期临床访视、CT扫描/胸部X线检查以及血液肿瘤标志物检测。本项分析中纳入的男性是在1984~2008年期间被诊断为Ⅰ期精原细胞瘤的，其数据采集持续至2012年12月，并且与全国注册数据相关联。

　　与在其他较小规模研究中观察到的情况相似，本项研究显示人绒毛膜促性腺激素水平升至200 IU/L以上、血管受到侵犯以及肿瘤直径＞4 cm的患者复发风险较高。

原文阅读：Postop surveillance sufficient for stage I testicular cancer
Surveillance is sufficient for most men with stage I seminoma after successful orchiectomy, according to the findings of the largest study ever performed to address the issue.
The 1,822 men followed only with surveillance in Denmark had an excellent disease-specific survival of 99.5%, Dr. Mette Saskø Mortensen said at a press briefing highlighting research to be presented at the upcoming American Society of Clinical Oncology annual meeting. Only 10 men died of testicular cancer or treatment-related causes during a median follow-up of 15.4 years.
This finding means that for every 1,000 men followed by a surveillance program, only 4 will die within 10 years, said incoming ASCO president Dr. Clifford Hudis, chief of breast cancer medicine service at Memorial Sloan-Kettering Cancer Center in New York.
He described the study as one of several recent reminders that sometimes "less is more" in patient care and noted that opting for surveillance spares patients from the harmful side effects of chemotherapy and radiation without diminishing their chances for long-term survival.
Seminoma is a relatively rare cancer, but it is the most common solid tumor among young men. Initial treatment is typically orchiectomy, but no standard postoperative management strategy has been established. The current results will likely accelerate the trend toward surveillance in the United States, where roughly 50% of men undergo either radiotherapy or chemotherapy with carboplatin after surgery.
Overall, 355 (19.5%) of the 1,822 men experienced a relapse during surveillance, said Dr. Mortensen, a PhD student in the oncology department at Copenhagen University Hospital.
The median time to relapse was 13.7 months, with the majority of patients (72.4%) relapsing within the first 2 years. Another 20.3% relapsed within years 2-5 and 7.3% after 5 years.
"With only 19.5% of the patients relapsing, the surveillance strategy spares the remaining 80% of patients from unnecessary treatment after orchiectomy," Dr. Mortensen said. "Surveillance is a safe strategy for stage I seminoma patients."
Surveillance has been the main follow-up strategy for stage I seminoma in Denmark since 1984, and consists of 5 years of scheduled clinical visits, computed tomography scans/chest x-rays, and blood measurements of tumor markers. Men in the analysis were diagnosed from 1984 to 2008, and their data were collected up to December 2012 from patient files and linked national registries.
As observed in other smaller studies, the risk for relapse was increased with elevated human chorionic gonadotropin levels of more than 200 IU/L, vascular invasion, and tumors larger than 4 cm, Dr. Mortensen said.
The study was supported in part by the Danish Cancer Society, Danish Research Foundation and the Preben and Anna Simonsen Foundation. Dr. Mortensen reported having no financial disclosures.