目的:睾丸生殖细胞肿瘤(GCT)是年轻男性中最常见的恶性肿瘤,所有病例中有三分之二表现为临床I期(CSI)。主动监测是当前指南最青睐的管理方式。这项系统评价评估了CSI患者的治疗结果,这些结果涉及非精原细胞瘤(NS)和纯精原细胞瘤(SE)的复发率和总体生存率,与辅助策略相比。
UNASSIGNED:我们进行了系统的文献综述,将搜索范围限制在2010-2021年发表的最新研究中,这些研究报告了监测与辅助治疗的直接比较。我们搜索了Medline和Cochrane图书馆,并对参考文献列表进行了其他手动搜索,以确定相关研究。纳入研究的数据提取和质量评估采用组织学分层(NS与SE)和治疗方式。结果用描述性统计方法制表和评价。
结果:34项研究符合纳入标准。在NS患者中,复发率为12%至37%,0到10%,0到11.8%用于监视,化疗和腹膜后淋巴结清扫术(RPLND),而总生存率为90.7-100%,91.7-100%,97-99.1%,分别。在SECSI中,复发率为0-22.3%,0-5%,0-12.5%用于监视,放射治疗,化疗,总生存率为84.1-98.7%,83.5-100%,92.3-100%,分别。
结论:在两个组织学亚组中,主动监测提供与辅助管理策略几乎相同的总生存期,然而,以更高的复发率为代价。CSIGCT患者的每种管理策略都有特定的优点,建议共同决策以定制治疗。
OBJECTIVE: Testicular germ cell tumours (GCTs) represent the most common malignancy in young adult males with two thirds of all cases presenting with clinical stage I (CSI). Active surveillance is the management modality mostly favoured by current guidelines. This systematic
review assesses the treatment results in CSI patients concerning recurrence rate and overall survival in non-seminoma (NS) and pure seminoma (SE) resulting from surveillance in comparison to adjuvant strategies.
UNASSIGNED: We performed a systematic literature
review confining the search to most recent studies published 2010-2021 that reported direct comparisons of surveillance to adjuvant management. We searched Medline and the Cochrane Library with additional hand-searching of reference lists to identify relevant studies. Data extraction and quality assessment of included studies were performed with stratification for histology (NS vs. SE) and treatment modalities. The results were tabulated and evaluated with descriptive statistical methods.
RESULTS: Thirty-four studies met the inclusion criteria. In NS patients relapse rates were 12 to 37%, 0 to 10%, and 0 to 11.8% for surveillance, chemotherapy and for retroperitoneal lymph node dissection (RPLND) while overall survival rates were 90.7-100%, 91.7-100%, and 97-99.1%, respectively. In SE CSI, relapse rates were 0-22.3%, 0-5%, and 0-12.5% for surveillance, radiotherapy, chemotherapy, while overall survival rates were 84.1-98.7%, 83.5-100%, and 92.3-100%, respectively.
CONCLUSIONS: In both histologic subgroups, active surveillance offers almost identical overall survival as adjuvant management strategies, however, at the expense of higher relapse rates. Each of the management strategies in CSI GCT patients have specific merits and shared-decision-making is advised to tailor treatment.