摘要
目的探讨原发睾丸恶性肿瘤的临床病理特征和治疗预后,以提高对该疾病的认识和诊疗水平。方法回顾性分析2010年2月至2015年2月我院收治的67例原发睾丸恶性肿瘤患者的临床资料,总结分析其临床、病理特征和诊断、治疗预后等。结果患者年龄8个月~84岁,平均39.0岁,左侧29例,右侧38例。1例合并有膀胱癌。15例(22.4%)有隐睾病史,其中2例为双侧,隐睾发生肿瘤的病理类型以精原细胞瘤最常见,为11例(73.3%)。血清肿瘤标志物(AFP,HCG,LDH):精原细胞瘤中有14例(42.4%)升高,非精原细胞瘤中有22例(91.7%)升高。生殖细胞肿瘤57例(85.0%),其中精原细胞瘤33例(49.2%)(包括伴合体滋养细胞精原细胞瘤1例,伴肉瘤成分的精母细胞型精原细胞瘤1例);非精原细胞瘤24例(35.8%),其中胚胎癌5例,卵黄囊瘤2例,混合性生殖细胞瘤17例;Leydig细胞瘤1例(1.5%);淋巴瘤(均为非霍奇金淋巴瘤,弥漫大B细胞型)6例(9.0%);肉瘤3例(4.5%)(脂肪肉瘤1例,胚胎性横纹肌肉瘤1例,滑膜肉瘤1例)。精原细胞瘤33例中,Ⅰ期24例,其中Ⅰa期16例,Ⅰs期8例;Ⅱ期7例,其中Ⅱa期1例,Ⅱb期2例,Ⅱc期4例;Ⅲb期2例。其他类型肿瘤34例中,Ⅰ期21例,其中Ⅰa期9例,Ⅰb期2例,Ⅰs期10例;Ⅱ期3例,其中Ⅱa期1例,Ⅱb期1例,Ⅱc期1例;Ⅲ期10例,其中Ⅲa期2例,Ⅲb期6例,Ⅲc期2例。Ⅰ期所占比例最高,为45例(67.2%),Ⅱ期10例(14.9%),Ⅲ期12例(17.9%),Ⅱ期和Ⅲ期无明显差别。治疗方面:精原细胞瘤行单纯根治性睾丸切除术(Radical Orchiectomy,RO)5例,RO+化疗20例,RO(其中1例+腹膜后淋巴结清扫术(Retroperitoneal Lymphnode Dissection,RPLND)+放疗3例,RO+放疗+化疗5例。其他类型肿瘤行RO 10例(其中1例+RPLND),单纯化疗1例,RO(其中2例+RPLND)+化疗20例,RO(其中1例+RPLND)+放疗+化疗3例。术后随访2~64月,平均48.8月,48例(71.6%)无肿瘤复发及转移,最终有19例(28.4%)死亡,其中精原细胞瘤4例,其他类型肿瘤15例。精原细胞瘤患者平均生存58.3月,其他类型肿瘤患者平均生存34.8月,两者差异有统计学意义(P<0.05)。结论睾丸肿瘤总体预后较好,预后同临床分期、病理类型密切有关,精原细胞瘤的预后要明显好于其他类型肿瘤,早期诊断和综合个体化治疗对改善其预后有重要意义。
Objective To explore the clinicopathological characteristics and prognosis of primary testicular malignant tumor,in order to improve the understanding,diagnosis and treatment of the disease.Methods The clinical data of 67 patients with primary testicular malignant tumor received in our hospital from February 2010 to February 2015 were analyzed retrospectively and their clinical features,pathological characteristics,diagnosis,treatment as well as prognosis were summarized and analyzed.Results The age of the patients ranged from 8 months to 84 years old,39.0 years for average,29 cases occurring on the left side and 38 cases occurring on the right side,with 1 case complicated with bladder carcinoma.15 cases(22.4%)had a history of cryptorchidism,of which 2 cases were bilateral.The most common pathological type of cryptorchidism tumor was seminoma,where there was 11 cases making up for 73.3%.As for serum tumor marker such as AFP,HCG and LDH,14 cases(42.4%)of seminoma and 22 cases(91.7%)of non-seminoma were observed an elevation.There were 57 cases of germinoma(85%),including 33 cases of seminoma(including 1 case of seminoma accompanied by syncytiotrophoblasts and 1 case of spermatocytic seminoma with sarcoma component)and 24 cases(35.8%)of non-seminoma,which consisted of 5 cases of embryonal carcinoma,2 cases of yolk sac tumor and 17 cases of mixed germ cell tumor.Additionally,there was 1 case(1.5%)of Leydig cell tumor,6 cases(9.0%)of lymphoma(all non-Hodgkin lymphoma and all diffuse large B cell lymphoma)and 3 cases(4.5%)of sarcoma(1 case of liposarcoma,1 case of embryonic rhabdomyosarcoma and 1 case of synovial sarcoma).Among the 33 cases of seminoma,24 cases were stagedⅠ,including 16 cases of stageⅠa and 8 cases of stageⅠs,7 cases were stagedⅡ,including 1 case of stageⅡa,2 cases of stageⅡb and 4 cases of stageⅡc,and 2 cases were stagedⅢb.Among the 34 cases of other types of tumors,21 cases were stagedⅠ,including 9 cases of stageⅠa,2 cases of stageⅠb and 10 cases of stageⅠs,3 cases were stagedⅡ,including 1 case of stageⅡa,1 case of stageⅡb and 1 case of stageⅡc,10 cases were stagedⅢ,2 cases of stageⅢa,6 cases of stageⅢb and 2 cases of stageⅢc.Patients stagedⅠaccounted for the highest proportion as 45 cases(67.2%),while 10 cases were stagedⅡ(14.9%)and 12 cases were stagedⅢ(17.9%).There was no statistically significant difference between stageⅡproportion and stageⅢproportion.As for treatment,5 cases of seminoma underwent simple radical orchiectomy(RO),20 cases of seminoma underwent RO plus chemotherapy,3 cases of seminoma underwent RO plus radiotherapy(including 1 case undergoing additional retroperitoneal lymph node dissection,RPLND)and 5 cases of seminoma underwent RO plus radiotherapy plus chemotherapy.For other types of tumors,10 cases underwent RO(including 1 case undergoing additional RPLND),1 case underwent simple chemotherapy,20 cases underwent RO plus chemotherapy(including 2 cases undergoing additional RPLND)and 3 cases underwent RO plus radiotherapy plus chemotherapy(including 1 case undergoing additional RPLND).Postoperative follow-up ranged from 2 to 64 months,with an average of 48.8 months.48 cases showed no recurrence or metastasis,and 19 cases finally died,including 4 cases of seminoma and 15 cases of other types of tumors.The average survival time of patients with seminoma was 58.3 months,while that of patients with other types of tumors was 34.8 months,the difference of survival time between the two groups being statistically significant(P<0.05).Conclusion The overall prognosis of testicular tumors is favorable,which is closely related to clinical stages and pathological types.The prognosis of seminoma is significantly better than that of other types of testicular tumors.Early diagnosis and comprehensive individualized treatment are of great significance to improve the prognosis of testicular tumors.
作者
李曾
廖洪
毛顿
谭政
吴毅
肖英明
杨盛柯
钟磊
Li Zeng;Liao Hong;Mao Dun(Urology Surgery,Sichuan Cancer Hospital,Chengdu,Sichuan 610041,China)
出处
《四川医学》
CAS
2018年第6期639-645,共7页
Sichuan Medical Journal
关键词
睾丸肿瘤
治疗
预后
回顾性分析
testicular tumors
treatment
prognosis
retrospective analysis
