Abstract：
BACKGROUND: Chemotherapy and radiation therapy are considered standard treatments for stage II seminoma patients; however, these therapies are associated with long-term toxicities. Recently, retroperitoneal lymph node dissection has emerged as an alternative strategy, and the first three phase II trials were published in 2023 with promising results. The present study conducted a systematic review and meta-analysis to evaluate this surgery as an alternative treatment for stage IIA/B seminoma patients.
OBJECTIVE: Seminomas are the most common testicular tumors, often affecting young adult males. Standard treatments for stage II seminomas include chemotherapy and radiation therapy, but these therapies are associated with long-term toxicities. Thus, identifying alternative strategies is paramount. Herein, we conducted a systematic review and meta-analysis to appraise the efficacy and safety of retroperitoneal lymph node dissection (RPLND) for treating this condition.
METHODS: We systematically searched the PubMed, Embase, and Cochrane databases for studies evaluating RPLND as a primary treatment for stage II A/B seminomas. Using a random-effects model, single proportion and means and pooled 2-year recurrence-free survival rates with hazard rates and 95% CI were calculated.
RESULTS: Seven studies were included, comprising 331 males with stage II seminomas. In the pooled analysis, the recurrence rate was 17.69% (95% CI 12.31-24.75), and the 2-year RFS rate was 81% (95% CI 0.77-0.86). The complication rate was 9.16% (95% CI 6.16-13.42), the Clavien-Dindo > 2 complication rate was 8.83% (95% CI 5.76-13.31), and the retrograde ejaculation rate was 7.01% (95% CI 3.54-13.40). The median operative time was 174.68 min (95% CI 122.17-249.76 min), median blood loss was 105.91 mL (95% CI 46.89-239.22 mL), and patients with no evidence of lymph node involvement ranged from 0-16%.
CONCLUSIONS: Primary RPLNDs for treating stage IIA/B seminomas have favorable RFS rates, with low complication and recurrence rates. These findings provide evidence that this surgery is a viable alternative therapy for these patients.
OBJECTIVE: Seminomas are the most common testicular tumors, often affecting young adult males. Standard treatments for stage II seminomas include chemotherapy and radiation therapy, but these therapies are associated with long-term toxicities. Thus, identifying alternative strategies is paramount. Herein, we conducted a systematic review and meta-analysis to appraise the efficacy and safety of retroperitoneal lymph node dissection (RPLND) for treating this condition.
METHODS: We systematically searched the PubMed, Embase, and Cochrane databases for studies evaluating RPLND as a primary treatment for stage II A/B seminomas. Using a random-effects model, single proportion and means and pooled 2-year recurrence-free survival rates with hazard rates and 95% CI were calculated.
RESULTS: Seven studies were included, comprising 331 males with stage II seminomas. In the pooled analysis, the recurrence rate was 17.69% (95% CI 12.31-24.75), and the 2-year RFS rate was 81% (95% CI 0.77-0.86). The complication rate was 9.16% (95% CI 6.16-13.42), the Clavien-Dindo > 2 complication rate was 8.83% (95% CI 5.76-13.31), and the retrograde ejaculation rate was 7.01% (95% CI 3.54-13.40). The median operative time was 174.68 min (95% CI 122.17-249.76 min), median blood loss was 105.91 mL (95% CI 46.89-239.22 mL), and patients with no evidence of lymph node involvement ranged from 0-16%.
CONCLUSIONS: Primary RPLNDs for treating stage IIA/B seminomas have favorable RFS rates, with low complication and recurrence rates. These findings provide evidence that this surgery is a viable alternative therapy for these patients.
摘要：
背景：化疗和放疗被认为是II期精原细胞瘤患者的标准治疗方法；然而，这些疗法与长期毒性有关.最近,腹膜后淋巴结清扫术已成为一种替代策略，前三项II期试验于2023年发表,结果有希望.本研究进行了系统回顾和荟萃分析，以评估该手术作为IIA/B期精原细胞瘤患者的替代治疗方法。
目的：精原细胞瘤是最常见的睾丸肿瘤，经常影响年轻的成年男性。II期精原细胞瘤的标准治疗包括化疗和放疗，但是这些疗法与长期毒性有关。因此，确定替代策略是至关重要的。在这里，我们进行了系统评价和荟萃分析,以评估腹膜后淋巴结清扫术(RPLND)治疗该疾病的有效性和安全性.
方法：我们系统地搜索了PubMed，Embase,和Cochrane数据库，用于评估RPLND作为IIA/B期精原细胞瘤的主要治疗方法。使用随机效应模型，我们计算了单一比例和均值,以及合并的2年无复发生存率,风险率和95%CI.
结果：纳入了7项研究，包括331名男性患有II期精原细胞瘤。在汇总分析中，复发率为17.69％（95％CI12.31-24.75），2年RFS率为81%(95%CI0.77-0.86)。并发症发生率为9.16%(95%CI6.16～13.42),Clavien-Dindo>2并发症发生率为8.83%（95%CI5.76-13.31），逆行射精率为7.01%(95%CI3.54～13.40)。中位手术时间为174.68分钟（95%CI122.17-249.76分钟），中位失血量为105.91mL（95%CI46.89-239.22mL），无淋巴结受累证据的患者为0-16%。
结论：用于治疗IIA/B期精原细胞瘤的原发性RPLND具有良好的RFS率，并发症和复发率低。这些发现提供了证据，表明该手术是这些患者的可行替代疗法。
目的：精原细胞瘤是最常见的睾丸肿瘤，经常影响年轻的成年男性。II期精原细胞瘤的标准治疗包括化疗和放疗，但是这些疗法与长期毒性有关。因此，确定替代策略是至关重要的。在这里，我们进行了系统评价和荟萃分析,以评估腹膜后淋巴结清扫术(RPLND)治疗该疾病的有效性和安全性.
方法：我们系统地搜索了PubMed，Embase,和Cochrane数据库，用于评估RPLND作为IIA/B期精原细胞瘤的主要治疗方法。使用随机效应模型，我们计算了单一比例和均值,以及合并的2年无复发生存率,风险率和95%CI.
结果：纳入了7项研究，包括331名男性患有II期精原细胞瘤。在汇总分析中，复发率为17.69％（95％CI12.31-24.75），2年RFS率为81%(95%CI0.77-0.86)。并发症发生率为9.16%(95%CI6.16～13.42),Clavien-Dindo>2并发症发生率为8.83%（95%CI5.76-13.31），逆行射精率为7.01%(95%CI3.54～13.40)。中位手术时间为174.68分钟（95%CI122.17-249.76分钟），中位失血量为105.91mL（95%CI46.89-239.22mL），无淋巴结受累证据的患者为0-16%。
结论：用于治疗IIA/B期精原细胞瘤的原发性RPLND具有良好的RFS率，并发症和复发率低。这些发现提供了证据，表明该手术是这些患者的可行替代疗法。
