RISK-ADAPTED TREATMENT CHOICE IN STAGE-I NONSEMINOMATOUS TESTICULAR GERM-CELL CANCER BY REGARDING VASCULAR INVASION IN THE PRIMARY TUMOR - A PROSPECTIVE TRIAL

被引:89
作者
PONT, J
HOLTL, W
KOSAK, D
MACHACEK, E
KIENZER, H
JULCHER, H
HONETZ, N
机构
[1] FRANZ JOSEF SPITAL,DEPT UROL & PATHOL,VIENNA,AUSTRIA
[2] KA RUDOLFSTIFTUNG,DEPT UROL & PATHOL,VIENNA,AUSTRIA
关键词
D O I
10.1200/JCO.1990.8.1.16
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Based on the results of a retrospective study, which found blood vessel invasion to be the most important prognostic factor in clinical stage I nonseminomatous testicular germ cell cancer (NSTGCC I), a prospective study was started in 1985 which assigned NSTGCC I patients without evidence of vascular invasion to surveillance and patients with vascular invasion to two cycles of adjuvant chemotherapy with cisplatin, etoposide, and bleomycin. Twenty-two patients entered the surveillance group and 18 patients received adjuvant chemotherapy. Median follow-up is 30 months (3 to 50 months). Relapses occurred in three patients (7.5%), one in the surveillance group (4.5%), two in the chemotherapy group (11%). Thirty-eight patients (95%) are alive and without evidence of disease. Two patients of the adjuvant-treated group died, one of progressive germ cell cancer and one of lung cancer. We conclude that low- and high-risk NSTGCC I patients can be identified by considering blood vessel invasion. The presence of embryonal carcinoma and vascular invasion seem to be interrelated prognostic factors, because in 94% of vessel invasion the invading element was embryonal carcinoma. The exclusion of patients with vascular invasion from surveillance decreases relapse rates remarkably. Adjuvant chemotherapy diminishes relapse rates in high-risk patients but does not entirely prevent relapse. © 1990 by American Society of Clinical Oncology.
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页码:16 / 20
页数:5
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