비정상피종성 고환 생식세포종양의 위험 인자와 생존율에 대한 분석
Clinical Experience of Nonseminomatous Germ Cell Testicular Tumor: Risk Factors and Survival Rate
소속 상세정보
송희원/Hee Won Song
정병하/홍성준/양승철/이진무/Byung Ha Chung/Sung Joon Hong/Seung Choul Yang/Jin Moo Lee
KMID : 0358319990400040453
Abstract
결론
본원에서 지난 15년간 비정상피종성 고환 생식세포 종양으로 진단되고 치료받았던 16세
이상의 환자들은 조직병리학적으로 혼합조직형, 기형종, 태생암, 기형암종 순의 빈도를 나타
내었고 80.4%에서 진단 당시에 종양지표의 의미 있는 상승을 보였다. 5년 생존율은 병기
Ⅰ, Ⅱ, Ⅲ에서 각각 95%, 80%, 56%를 보였으며, 전체 5년 생존율은 82%였다. 병기 Ⅰ 비
정상피종성 고환 생식세포종양 환자들 중 고환절제술시에 병리학적 위험요소(태생암조직형
의 존재, 국소병기 T2이상, 혈관 및 림프관 침범)를 갖고 있는 군은 병리학적
위험요소를 갖고 있지 않는 군에 비해 통계학적으로 유의하게 재발율이 증가되어 있었으므
로 이렇게 병리학적 위험요소를 갖고 있는 병기 Ⅰ 환자들에서는 선별적으로 조기에 후복막
림프절절제술 혹은 항암제요법 등의 적극적인 치료가 필요할 것으로 생각된다.
Purpose : We reviewed clinical features and survival rates of nonseminomatous germ
cell testicular tumors(NSGCTs) and analyzed pathological risk factors of relapse in stage
1 group under surveillance program.
Materials and Methods : Forty one patients were treated for primary NSGCTs from
February 1983 to April 1998. 20(48.8%) patients were stage Ⅰ and 19 of them were
followed up under surveillance program after orchiectomy and 1 underwent orchiectomy
and adjuvant therapy(RPLND and PVB chemotherapy). 11(26.8%) were stage Ⅱ and
10(24.4%) stage Ⅲ and all stage Ⅱ and Ⅲ patients underwent orchiectomy and adjuvant
therapy. Statistical analysis with Fisher's exact test was performed to identify that
pathological risk factors affected relapse rate.
Results : Mean age at diagnosis was 26 year(range 16-47) and mean follow-up period
was 58 month(range 5-163). According to histopathological types, embryonal carcinoma,
teratoma, teratocarcinoma and mixed type represented 19.5%, 26.8%, 7.3% and 46.3%,
respectively. Among 41 patients, 33 showed significant elevation of tumor markers at
diagnosis. The 5-year survival rates of stage Ⅰ, Ⅱ and Ⅲ were 95%, 80% and 56%,
respectively and overall 5-year survival rate was 82%. Among stage Ⅰ patients under
surveillance program, there was statistically significant increase of relapse rate in the
patients with pathological risk factors(presence of embryonal elements, local stage
T2 or higher, presence of lymphovascular invasion) as compared to those
without.
Conclusions : In stage Ⅰ NSGCT patients, if there are pathological risk factors after
orchiectomy, aggressive therapy such as early retroperitoneal lymph node dissection or
chemotherapy is selectively needed.
키워드
Nonseminomatous germ cell testicular tumor; Relapse; Pathological risk factors;
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