PDF(Pubmed)
Abstract：
UNASSIGNED: There is an unmet need to avoid long-term morbidity associated with standard cytotoxic treatment for low-volume metastatic seminoma. Our aim was to assess the oncological efficacy and surgical safety of retroperitoneal lymph node dissection (RPLND) as treatment in a population-based cohort of metastatic seminoma patients with limited retroperitoneal lymphadenopathy.
UNASSIGNED: Sixty-two seminoma patients in Norway and Sweden were included in the cohort from 2019 to 2022. Patients with lymphadenopathy ≤3 cm, having primary clinical stage (CS) IIA/B or CS I with a relapse, were operated with uni- or bilateral template RPLND, open or robot assisted. The outcome measures included surgical complications as per Clavien-Dindo, and Kaplan-Meier survival estimates for 24-mo progression-free survival (PFS) and overall survival (OS).
UNASSIGNED: In the cohort, 33 (53%) had CS I with a relapse during surveillance, six (10%) CS I with a relapse following adjuvant chemotherapy, and 23 (37%) initial CS IIA/B. Metastatic seminoma was verified in 58 patients (94%) with a median largest diameter of 18 mm (interquartile range [IQR] 13-24). Robot-assisted RPLND was performed in 40 patients (65%). Clavien-Dindo III complications were observed in three patients (5%); no grade ≥IV complications occurred. Eighteen patients (29%) received adjuvant chemotherapy after surgery. The median follow-up was 23 mo (IQR 16-30), and recurrence occurred in six patients (10%) after a median of 8 mo (IQR 4-14). PFS was 90% (95% confidence interval: 0.86-1) and OS was 100% at 24 mo.
UNASSIGNED: RPLND as primary treatment is an option for selected low-stage seminomas with a limited burden of disease, showing low complications and low relapse rates, with the potential to reduce long-term morbidity.
UNASSIGNED: In seminoma patients with limited metastatic spread, surgery is a treatment option offering an alternative to chemotherapy or radiation. This paper covers the first 62 patients operated in Norway and Sweden.
UNASSIGNED: Sixty-two seminoma patients in Norway and Sweden were included in the cohort from 2019 to 2022. Patients with lymphadenopathy ≤3 cm, having primary clinical stage (CS) IIA/B or CS I with a relapse, were operated with uni- or bilateral template RPLND, open or robot assisted. The outcome measures included surgical complications as per Clavien-Dindo, and Kaplan-Meier survival estimates for 24-mo progression-free survival (PFS) and overall survival (OS).
UNASSIGNED: In the cohort, 33 (53%) had CS I with a relapse during surveillance, six (10%) CS I with a relapse following adjuvant chemotherapy, and 23 (37%) initial CS IIA/B. Metastatic seminoma was verified in 58 patients (94%) with a median largest diameter of 18 mm (interquartile range [IQR] 13-24). Robot-assisted RPLND was performed in 40 patients (65%). Clavien-Dindo III complications were observed in three patients (5%); no grade ≥IV complications occurred. Eighteen patients (29%) received adjuvant chemotherapy after surgery. The median follow-up was 23 mo (IQR 16-30), and recurrence occurred in six patients (10%) after a median of 8 mo (IQR 4-14). PFS was 90% (95% confidence interval: 0.86-1) and OS was 100% at 24 mo.
UNASSIGNED: RPLND as primary treatment is an option for selected low-stage seminomas with a limited burden of disease, showing low complications and low relapse rates, with the potential to reduce long-term morbidity.
UNASSIGNED: In seminoma patients with limited metastatic spread, surgery is a treatment option offering an alternative to chemotherapy or radiation. This paper covers the first 62 patients operated in Norway and Sweden.
摘要：
■对于低体积转移性精原细胞瘤，存在未满足的避免与标准细胞毒性治疗相关的长期发病率的需求。我们的目的是评估腹膜后淋巴结清扫术（RPLND）作为腹膜后淋巴结肿大的转移性精原细胞瘤患者人群队列的肿瘤学疗效和手术安全性。
■从2019年到2022年，挪威和瑞典的62例精原细胞瘤患者被纳入队列。淋巴结肿大≤3cm的患者，具有复发的主要临床阶段（CS）IIA/B或CSI，使用单模板或双侧模板RPLND进行手术，打开或机器人辅助。结果测量包括根据Clavien-Dindo的手术并发症，24个月无进展生存期（PFS）和总生存期（OS）的Kaplan-Meier生存期估计。
■在队列中，33例（53%）的CSI在监测期间复发，六个（10％）CSI在辅助化疗后复发，和23（37％）初始CSIIA/B。在58例患者（94％）中证实了转移性精原细胞瘤，中位最大直径为18mm（四分位距[IQR]13-24）。机器人辅助RPLND40例（65%）。在3例患者（5％）中观察到Clavien-DindoIII并发症；没有发生≥IV级并发症。18例(29%)患者术后接受辅助化疗。中位随访时间为23个月(IQR16-30)，6例患者(10%)在中位时间8个月后复发(IQR4-14).24个月时PFS为90%（95%置信区间：0.86-1），OS为100%。
■RPLND作为主要治疗是选择疾病负担有限的低阶段精原细胞瘤的一种选择，显示低并发症和低复发率，有可能降低长期发病率。
■在转移性扩散有限的精原细胞瘤患者中，手术是一种替代化疗或放疗的治疗选择。本文涵盖了在挪威和瑞典进行手术的前62名患者。
■从2019年到2022年，挪威和瑞典的62例精原细胞瘤患者被纳入队列。淋巴结肿大≤3cm的患者，具有复发的主要临床阶段（CS）IIA/B或CSI，使用单模板或双侧模板RPLND进行手术，打开或机器人辅助。结果测量包括根据Clavien-Dindo的手术并发症，24个月无进展生存期（PFS）和总生存期（OS）的Kaplan-Meier生存期估计。
■在队列中，33例（53%）的CSI在监测期间复发，六个（10％）CSI在辅助化疗后复发，和23（37％）初始CSIIA/B。在58例患者（94％）中证实了转移性精原细胞瘤，中位最大直径为18mm（四分位距[IQR]13-24）。机器人辅助RPLND40例（65%）。在3例患者（5％）中观察到Clavien-DindoIII并发症；没有发生≥IV级并发症。18例(29%)患者术后接受辅助化疗。中位随访时间为23个月(IQR16-30)，6例患者(10%)在中位时间8个月后复发(IQR4-14).24个月时PFS为90%（95%置信区间：0.86-1），OS为100%。
■RPLND作为主要治疗是选择疾病负担有限的低阶段精原细胞瘤的一种选择，显示低并发症和低复发率，有可能降低长期发病率。
■在转移性扩散有限的精原细胞瘤患者中，手术是一种替代化疗或放疗的治疗选择。本文涵盖了在挪威和瑞典进行手术的前62名患者。
