目的:关于睾丸生殖细胞肿瘤(TGCT)伴静脉癌栓(VTT)的患病率和治疗的资料有限。我们的目标是描述TGCT与VTT的患病率,为了确定多中心回顾性队列,并确定有关该实体最佳管理的专家意见。
方法:使用IBMMarketscan数据库,我们确定了患有睾丸癌的男性患者,他们接受了腹膜后淋巴结清扫术(RPLND)并同时行VTT或下腔静脉(IVC)肿瘤血栓切除术,以估计VTT在TGCT中的患病率.为了确定患者的多中心回顾性队列,我们调查了外科医生并描述了演讲,管理,以及队列的结果。
在IBMMarketscan数据库中,使用严格标准时,TGCT与VTT的患病率为0.3%(n=7/2517),使用宽泛标准时,TGCT的患病率为3.1%(n=79/2517)。作为对我们调查的回应,来自10个中心的16名外科医生为34名患者提供了数据。大多数患者(n=29,85%)表现为非精原细胞生殖细胞肿瘤。手术治疗用于93.9%(n=31),包括63%的化疗后肿瘤血栓切除术和原发性腔内修补术。Marketscan分析仅限于被保险人,不包括临床病理细节,使用账单代码可能包括间质瘤患者。此外,缺乏对匿名调查的回应有限的数据捕获,RedCap调查未解决IVC梗阻特有的症状,也未对导致VTT诊断的影像学进行集中审查.
结论:VTT在TGCT男性中是罕见的,需要复杂的多学科管理,包括RPLND化疗后静脉肿瘤血栓切除术。
结果:使用医疗数据库,我们估计睾丸癌病例的频率,其中肿瘤延伸到血管(称为静脉肿瘤血栓,VTT)仅为0.3-3.1%。我们对有这种情况经验的外科医生进行了调查。我们的结果表明,尽管睾丸癌对化疗反应良好,对于这种罕见的情况,VTT反应性较差,需要复杂的手术。
OBJECTIVE: There are limited data on the prevalence and management of testicular germ cell tumor (TGCT) cases presenting with venous tumor thrombus (VTT). Our objectives were to describe the prevalence of TGCT with VTT, to identify a multicenter retrospective cohort, and to ascertain expert opinion regarding optimal management of this entity.
METHODS: Using the IBM Marketscan database, we identified men with testicular cancer who underwent retroperitoneal lymph node dissection (RPLND) with concurrent VTT or inferior vena cava (IVC) tumor thrombectomy to estimate the prevalence of VTT in TGCT. To identify a multicenter retrospective cohort of patients, we surveyed surgeons and described the presentation, management, and outcomes for the cohort.
UNASSIGNED: The prevalence of TGCT with VTT in the IBM Marketscan database was 0.3% (n = 7/2517) when using stringent criteria and 3.1% (n = 79/2517) when using broad criteria. In response to our survey, 16 surgeons from ten centers contributed data for 34 patients. Most patients (n = 29, 85%) presented with nonseminomatous germ cell tumor. Surgical management was used for 93.9% (n = 31), including postchemotherapy tumor thrombectomy with primary cavorrhaphy in 63%. The Marketscan analysis was limited to insured individuals and did not include clinicopathological details, and use of billing codes may have included patients with stromal tumors. In addition, lack of responses to the anonymous survey limited data capture, and the RedCap survey did not address symptoms specific to IVC obstruction or allow central review of the imaging leading to VTT diagnosis.
CONCLUSIONS: VTT among males with TGCT is rare and requires complex multidisciplinary management, including venous tumor thrombectomy at the time of postchemotherapy RPLND.
RESULTS: Using a medical database, we estimated that the frequency of testicular cancer cases in which the tumor extends into a blood vessel (called venous tumor thrombus, VTT) is just 0.3-3.1%. We carried out a survey of surgeons with experience of this condition. Our results indicate that although testicular cancers respond well to chemotherapy, VTT is less responsive and complex surgery is necessary for this rare condition.