294例睾丸精原细胞瘤的远期疗效分析

目的 总结睾丸精原细胞瘤的远期疗效并探讨其治疗策略.方法 回顾性分析294例睾丸精原细胞瘤患者的临床资料.按1997年国际抗癌联盟(UICC)的TNM分期标准,Ⅰ期260例,Ⅱ期16例,Ⅲ期18例.治疗方法为手术切除原发病灶联合化疗和(或)放疗.数据分析采用SPSS13.0统计软件,生存分析应用Kaplan-Meier法,总生存率的比较采用Log rank方法检验.结果 全组294例患者的5、10、20和30年总生存率分别为92.1%、91.8%、85.5%和71.4%.临床分期对总生存率有显著影响.Ⅰ期患者中,术后辅助治疗者与未行辅助治疗者的10年总生存率分别为97.5%和79.2%,经辅助治疗者的生存明显获益(P=0.001).Ⅱ期和Ⅲ期患者的预后均与治疗方法无关(均P＞0.05).结论 睾丸精原细胞瘤对放化疗敏感,即使出现复发转移的患者仍有长期生存可能.治疗时应充分考虑患者的生活质量,尽量避免大范围手术切除和长期化疗.

Long-term outcome of testicular seminoma in 294 patients

Objective To analyze the correlation of long-term survival with the treatment strategies in patients with testicular seminoma.Methods Clinical data of 294 patients with testieular seminoma treated in our hospital between 1959 and 2004 were collected and analyzed.The median age of the patients was 37 years(range 13-70 years).Among them,260 were in stage Ⅰ disease,16 in stage Ⅱ,and 18 in stage Ⅲ.The patients were treated by surgical resection plus chemotherapy and/or radiotherapy.The survival rate was talcdated using Kaplan-Meier method and log-rank test using SPSS 13.0 software.Results The overall 5-,10-,20-and 30-year survival rates in this series were 92.1%,91.8%,85.5% and 71.4%,respectively.The major prognostic factor was found to be clinical stage.The patients with adjuvant chemotherapy after orchiectomy had better 10-year survival than the patients witIlout(97.5% vs.79.2%,P=0.001).For stage Ⅱ/Ⅲ patients,the patients with chemotherapy and the patients with chemotherapy plus radiotherapy had a similar progression-free survival(PFS)and overall survival(OS)(P＞0.05).Conclusion Testicular seminoma is sensitive to chemotherapy and radiotherapy.and a good cure rate can still be achieved in the relapsed patients with a salvage treatment.Therefore.wide excision and long-term chemotherapy should be avoided in order to maintain the quality of life in those patients.