Kontroverzie v manažmente neseminomatóznych germinatívnych nádorov testis v I. klinickom štádiu

English version

Autoři: D. Ondrus ¹; K. Kajo ²; V. Stastna ³; M. Ondrusova ^4,5
Působiště autorů: 1st Department of Oncology, Comenius University Faculty of Medicine, St. Elisabeth Cancer Institute, Bratislava, Slovak Republic ¹; Department of Pathology, Slovak Medical University, St. Elisabeth Cancer Institute, Bratislava, Slovak Republic ²; Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University in Trnava, Slovak Republic ³; St. Elizabeth University of Health and Social Sciences, Bratislava, Slovak Republic ⁴; Cancer Research Institute, Slovak Academy of Sciences, Bratislava, Slovak Republic ⁵
Vyšlo v časopise: Klin Onkol 2015; 28(2): 112-115
Kategorie: Původní práce
doi: https://doi.org/10.14735/amko2015112

Souhrn

Prísny dohľad po orchiektómii samotnej sa stal populárnym v manažmente neseminomatóznych germinatívnych nádorov testis v I. klinickom štádiu (clinical stage I nonseminomatous germ cell testicular tumors – CSI NSGCTT). Úsilie identifikovať pacientov s vysokým rizikom progresie ochorenia viedlo k vyhľadávaniu rizikových faktorov u CSI NSGCTT. Cieľom súčasnej štúdie bolo analyzovať dlhoročné skúsenosti s liečebnými postupmi založenými na prítomnosti rizikových faktorov (prísny dohľad a adjuvantná chemoterapia). V období 1/ 1992– 2/ 2015 bolo celkovo 454 pacientov s CSI NSGCTT zaradených do štúdie. Stratifikovali sa do dvoch skupín podľa použitých liečebných postupov v závislosti na prítomnosti rizikových faktorov. Skupina A (CSI NSGCTT s nízkym rizikom) pozostávala z 287 pacientov ktorí podstúpili prísny dohľad, progresia ochorenia sa zistila u 48 (16,7 %) pacientov po mediáne sledovania 7,0 mesiacov. Šesť pacientov (2,1 %) v tejto skupine zomrelo po mediáne sledovania 34,3 mesiacov. Skupina B (CSI NSGCTT s vysokým rizikom) pozostávala z 167 pacientov, ktorí boli dostávali adjuvantnú chemoterapiu, progresia ochorenia sa zistila u dvoch pacientov (1,2 %) s mediánom sledovania 56,2 mesiacov. Jeden pacient (0,6 %) zomrel 139,4 mesiacov po orchiektómii. Štatisticky významný rozdiel medzi oboma skupinami sa zistil v prežívaní bez progresie ochorenia, avšak nevýznamný bol rozdiel v celkovom prežívaní.

Klúčové slová:
testikulárne nádory – prísny dohľad – adjuvantná chemoterapia – progresia ochorenia

Práca bola podporená grantom Agentúry pre podporu výskumu a vývoja APVV – 0016-11.

Autoři deklarují, že v souvislosti s předmětem studie nemají žádné komerční zájmy.

Redakční rada potvrzuje, že rukopis práce splnil ICMJE kritéria pro publikace zasílané do biomedicínských časopisů.

Obdrženo:
4. 3. 2015

Přijato:
8. 3. 2015

Zdroje

1. Einhorn LH, Donohue J. Cis‑ diamminedichloroplatinum, vinblastine, and bleomycin combination chemotherapy in disseminated testicular cancer. Ann Intern Med 1977; 87(3): 293– 298.

2. Peckham MJ, Barrett A, Husband JE et al. Orchidectomy alone in testicular stage I nonseminomatous germ cell tumors. Lancet 1982; 2(8300): 678– 680.

3. Johnson DE, Lo RK, von Eschenbach AC et al. Surveillance alone for patients with clinical stage I nonseminomatous germ cell tumors of the testis: preliminary report. J Urol 1984; 131(3): 491– 493.

4. Sogani P, Whitmore WF, Herr HW et al. Orchiectomy alone in the treatment of clinical stage I nonseminomatous germ cell tumor of the testis. J Clin Oncol 1984; 2(4): 267– 270.

5. Thompson PI, Nixon J, Harvey VJ. Disease relapse in patients with stage I nonseminomatous germ cell tumor of the testis on active surveillance. J Clin Oncol 1988; 6(10): 1597– 1603.

6. Ondrus D, Hornak M. Orchiectomy alone for clinical stage nonseminomatous germ cell tumors of the testis (NSGCTT): a minimum follow‑up period of 5 years. Tumori 1994; 80(5): 362– 364.

7. Sturgeon JF, Jewett MA, Alison RE et al. Surveillance after orchiectomy for patients with clinical stage I nonseminomatous testis tumors. J Clin Oncol 1992; 10(4): 564– 568.

8. Klepp O, Olsson AM, Henrikson H et al. Prognostic factors in clinical stage I nonseminomatous germ cell tumors of the testis: multivariate analysis of a prospective multicenter study. J Clin Oncol 1990; 8(3): 509– 518.

9. Wishnow KI, Johnson DE, Swanson, DA et al. Identifying patients with low risk clinical stage nonseminomatous testicular tumors who should be treated by surveillance. Urology 1989; 34(6): 339– 343.

10. Ondrus D, Hornak M, Vrabec J. Low sperm counts as a prognostic factor of progression in stage I non‑seminomatous germ cell testicular tumours. Br J Urol 1988; 62(2): 82– 84.

11. Ondrus D, Gonçalves F, Kausitz J et al. The value of prognostic factors in the management of stage I nonseminomatous germ cell testicular tumors (NSGCTT). Neoplasma 1996; 43(3): 195– 197.

12. Ondrus D, Matoska J, Belan V et al. Prognostic factors in clinical stage I nonseminomatous germ cell testicular tumors: rationale for different risk‑adapted treatment. Eur Urol 1998; 33(6): 562– 566.

13. Ondrus D, Ondrusova M, Hornak M et al. Nonseminomatous germ cell testicular tumors – clinical stage I: differentiated therapeutic approach in comparison with therapeutic approach using surveillance strategy only. Neoplasma 2007; 54(5): 437– 442.

14. Krege S, Beyer J, Souchon R et al. European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus group (EGCCCG): part I. Eur Urol 2008; 53(3): 478– 496.

15. Albers P, Albrecht W, Algaba F et al. EAU guidelines on testicular cancer: 2011 update. Eur Urol 2011; 60(2): 304– 319. doi: 10.1016/ j.eururo.2011.05.038.

16. Coleman S, Stephenson A. Controversies in the management of stage I non‑seminomatous germ cell tumors. Curr Urol Rep 2013; 14(5): 506– 510. doi: 10.1007/ s11934‑ 013‑ 0362‑ 5.

17. Albers P, Siener, R, Kliesch S et al. Risk factors for relapse in clinical stage I nonseminomatous testicular germ cell tumors: results of the German Testicular Cancer Study Group Trial. J Clin Oncol 2003; 21(8): 1505– 1512.

18. Brewster SF. Challenging the EAU 2009 guidelines on testis cancer: the risk‑adapted management of stage I nonseminomatous germ cell tumours: surveillance yields equal results with less toxicity. Eur Urol 2010; 1 (Suppl): 459– 461.

19. Kollmansberger CH, Tandstad T, Bedard, PL et al. Patterns of relapse in patients with clinical stage I testicular cancer managed with active surveillance. J Clin Oncol 2015; 33(1): 51– 57. doi: 10.1200/ JCO.2014.56.2116.

20. Sturgeon JF, Moore MJ, Kakiashvili DM et al. Non‑ risk‑adapted surveillance in clinical stage I nonseminomatous germ cell tumors: the Princess Margaret Hospital‘s experience. Eur Urol 2011; 59(4) 556– 562. doi: 10.1016/ j.eururo.2010.12.010.

21. Nichols CR, Roth B, Albers P et al. Active surveillance is the prefered approach to clinical stage I testicular cancer. J Clin Oncol 2013; 31(28): 3490– 3493. doi: 10.1200/ JCO.2012.47.6010.

22. Jewett MAS, Richie JP, Albers P. Treatment of nonseminoma: Stage I. In: Laguna MP, Albers P, Bokemeyer C, Richie JP (eds). Cancer of the testis. London: Springer Verlag 2010: 147– 166.

23. Tandstad T, Dahl O, Cohn‑ Cedermark G et al. Risk‑adapted treatment in clinical stage I nonseminomatous germ cell testicular cancer: The SWENOTECA management program. J Clin Oncol 2009; 27(13): 2122– 2128. doi: 10.1200/ JCO.2008.18.8953.

24. Tandstad T, Ståhl O, Håkansson U et al. One course of adjuvant BEP in clinical stage I nonseminoma mature and expanded results from the SWENOTECA group. Ann Oncol 2014; 25(11): 2167– 2172. doi: 10.1093/ annonc/ mdu375.

25. Albers P, Siener R, Krege S et al. Randomized phase IIItrial comparing retroperitoneal lymph node dissection with one course of bleomycin and etoposide plus cisplatin chemotherapy in the adjuvant treatment of clinical stage I nonseminomatous testicular germ cell tumors: AUO trial AH 01/ 94 by the German Testicular Cancer Study Group. J Clin Oncol 2008; 26(18): 2966– 2972. doi: 10.1200/ JCO.2007.12.0899.

26. Westermann DH, Studer UE. High‑risk clinical stage Inonseminomatous germ cell tumors: the case for chemotherapy. World J Urol 2009; 27(4): 455– 461. doi: 10.1007/ s00345‑ 009‑ 0456‑ 3.

27. Abrahamova J. Therapeutic approaches for early stage nonseminomatous germ cell testicular tumors. Klin Onkol 2008; 21(3): 81– 85.

28. Lakomy R, Poprach A, Nemecek R et al. Adjuvant treatment for stage I of testicular germ cell tumours. Klin Onkol 2009; 22(1): 22– 26.

29. Oldenburg J, Aparicio J, Beyer J et al. Personalizing, not patronizing: the case for patient autonomy by unbiased presentation of management options in stage I testicular cancer. Ann Oncol (2014). doi: 10.1093/annonc/mdu514. First published online: November 6, 2014.