摘要
目的:探讨睾丸混合性生殖细胞肿瘤(MGCT)的临床特点、治疗及预后。方法:纳入南华大学附属第一医院和四川大学华西医院2007年12月至2012年12月、经手术及病理检查证实的27例睾丸MGCT患者,其中儿童2例,成人25例;发病年龄7个月至63岁,平均年龄29. 5岁。对其临床资料进行回顾性分析,并结合相关文献进行分析和讨论。结果:病理结果提示肿瘤成分包括卵黄囊瘤(13例,48. 1%)、精原细胞瘤(13例,48. 1%)、胚胎性癌(18例,66. 7%)、绒毛膜癌(4例,14. 8%)、畸胎瘤(17例,63. 0%)。其中15例(55. 6%)包含2种不同的生殖细胞肿瘤成分,11例(40. 7%)包含3种肿瘤成分。Ⅰ期18例(66. 7%),Ⅱ期6例(22. 2%),Ⅲ期3例(11. 1%)。所有患者均行根治性睾丸切除术,其中3例Ⅱ期、1例Ⅲ期患者行腹股沟或腹膜后淋巴结清扫术(RPLND),同时术后行2个周期的顺铂+鬼臼乙叉贰+博莱霉素(BEP)规律化疗; 3例Ⅱ期、2例Ⅲ期患者拒绝行RPLND,且其中1例Ⅲ期患者术后拒绝化疗,其余4例患者采用了2个周期的BEP化疗方案。术后平均随访时间36个月,Ⅰ期及Ⅱ期患者失访5例(5/24,20. 8%)、Ⅲ期失访1例(1/3,33. 3%); 3例Ⅰ期患者及2例Ⅱ期患者出现腹膜后转移,再次行RPLND后+2～3个周期BEP化疗,至今未复发;Ⅲ期患者死亡1例,1例随访38个月存活。结论:MGCT患者多以阴囊包块或阴囊不适就诊,病理类型多包括2～3种生殖细胞成分混合,胚胎性癌成分最多见;腹膜后淋巴结转移多见;Ⅱ期及以上患者行RPLND,术后辅以2～3个周期BEP规范化疗有较高的生存率和较低的复发率,并且对于术后复发患者也有较好效果。
Objective： To investigate the clinical features,diagnosis,treatment and prognosis of testicular mixed germ cell tumors（ TMGCT）. Methods： This retrospective study included 27 cases（ 2 children and 25 adults） of TMGCT confirmed surgically and pathologically in our hospital from December 2007 to December 2012. The patients＇ ranged in the age of onset from 7 months to 63 years,averaging at 29. 5 years. We analyzed the clinical data and reviewed the related literature. Results： At pathological examination,the TMGCTs displayed a variety of subtypes,including 13 cases of yolk sac tumor（ 48. 1%）,13 cases of seminoma（ 48. 1%）,18 cases of embryonal carcinoma（ 66. 7%）,4 cases of choriocarcinoma（ 14. 8%） and 17 cases of teratoma（ 63. 0%）. Of the total number of cases,15（ 55. 6%） contained two different germ cell histological elements,11（ 40. 7%） contained three,and 1（ 3. 7%）contained four; 18 cases（ 66. 7%） were in stage Ⅰ,6（ 22. 2%） in stage Ⅱ,and 3（ 11. 1%） in stage Ⅲ. All the patients underwent radical orchiectomy and,in addition,retroperitoneal lymph node dissection（ RPLND） ＋ BEP chemotherapy was administered for3 cases of stage Ⅱ and 1 case of stage Ⅲ. Three cases of stage Ⅱ and 2 cases of stage Ⅲ refused RPLND and 1 case of stage Ⅲ refused chemotherapy. A 27-49-month（ mean 30 months） follow-up was completed for 21 of the patients,during which retroperitoneal metastasis was found in 3 cases of stage Ⅰ and 2 cases of stage Ⅱ,who again received RPLND ＋ BEP and experienced no more recurrence. One case of stage Ⅲ refused both RPLND and chemotherapy and died at 12 months. Conclusion： TMGCT is a rare carcinoma with atypical clinical features,mostly comprising two or three different germ cell histological elements. Comprehensive treatment of RPLND combined with BEP chemotherapy may achieve a high survival rate and reduce recurrence for most of the patients with TMGCT of stage Ⅱ or above.
作者
陈力博
刘志洪
王豪
刘世敏
CHEN Li-bo;LIU Zhi-hong;WANG Hao;LIU Shi-min(Department of Urology,The First Hospital Affiliated to Nanhua University,Hengyang,Hunan 421001,China;Department of Urology,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,China)
出处
《中华男科学杂志》
CAS
CSCD
北大核心
2018年第11期987-991,共5页
National Journal of Andrology
