성인 고환 생식세포종양: 임상적 고찰 및 재발 위험인자
Adult Testicular Germ Cell Tumor: Clinical Characteristics and Risk Factors for Recurrence
소속 상세정보
이상은/Sang Eun Lee
김대영/서성일/정진수/박문수/이은식/최황/이종욱/Dae Young Kim/Seong Il Seo/Jin Soo Chung/Moon Soo Park/Eun Sik Lee/Hwang Choi/Chong Wook Lee
KMID : 0358319990400091145
Abstract
서론
고환 종양은 남성의 악성 종양 중 약 1%정도를 차지하는 비교적 드문 질환이나 15-34세
의 젊은 남성에서 가장 흔한 악성 종양이다. 지난 20년간 전산화단층촬영 및 초음파 영상의
발달, 방사선면역측정 방법에 의한 alpha fetoprotein(AFP)과 beta human chorionic
gonadotropin(β-hCG)같은 종양지표의 개발로 치료 효과에 대한 정확한 판단을 내릴 수 있
으며, 방사선학적으로 발견되는 잔존 병소의 수술적 치료와 방사선 치료법과 항암화학요법
의 발전 및 개발로 인해 현재는 모든 고형종양 중 가장 예후가 좋은 종양으로 95%의 완치
율을 보이고 있다. 따라서 대부분의 연구들에서 주된 관심사는 치료에 따른 부작용이나 후
유증을 최소화하면서 현재의 높은 완치율을 유지찰 수 있는 치료 방법 개발에 촛점이 모아
지고 있다.
이에 저자들은 지난 13년간 서울대병원에서 치료받은 17세 이상의 성인 고환 종양 환자를
후향적으로 추적조사하여 이들에 대한 병력지 및 병리소견을 분석하여 임상특성 및 재발의
위험인자에 대해 알아보고자 하였다.
Purpose : We reviewed clinical characteristics and prognostic factors in testicular germ
cell tumor in adults.
Materials and Methods : We reviewed the records of 42 patients with testicular germ
cell tumors managed at Seoul National University Hospital between January 1985 and
May 1997. Patients were followed regularly to determine clinical outcome with tumor
markers, chest X-ray and abdominal CT. Mean follow-up was 5.75 years ranging from
3 months to 238 months.
Results : Painless testiscular enlargement(86%) was the most common presenting
symptom and history of cryptorchidism was noted in 6 patients. Among 21 seminoma
patients, 11 were stage Ⅰ, 9 were stage Ⅱ, and 1 was unknown and among 21
nonseminomatous germ cell tumor(NSGCT) patients, 14 were stage Ⅰ, 1 was stage Ⅱ,
5 were stage Ⅲ, and 1 was unknown. Of the 11 patients with stage Ⅰ seminoma, there
was no recurrence in 7 patients who received retroperitoneal low-dose radiation therapy
after orchiectomy, but 2(50%) of 4 patients who had surveillance after orchiectomy,
showed relapse at retroperitoneal lymph nodes. One of 3 patients who had elevated level
of serum β-HCG at initial presentation showed tumor relapse at retroperitoneal lymph
node. Among 11 patients with stage Ⅰ NSGCT under surveillance after radical
orchiectomy, 7 patients(63.6%) had relapse. Vascular invasion of tumor was noted in
orchiectomy specimens in 3 cases of the 7 relapsed cases compared to no vascular
invasion in 4 non-relapsed cases. Also, 4 of 7 patients with elevation of tumor marker
resulted in relapse. Although primary pathologic stage T2 was noted in 2 patients with
clinical stage Ⅰ NSGCT, no recurrence occurred after adjuvant combined chemotherapy.
Fifteen patients with stage Ⅱ or stage Ⅲ were treated with systemic combination
chemotherapy after radical orchiectomy and 7 of these patients had residual
retroperitoneal mass. Of these patients, salvage chemotherpy was done in 2 patients,
salvage RPLND and salvage chemotherapy with RPLND was performed in 1 patient
respectively. Of the patients with stage Ⅱ or Ⅲ. One patient with stage ⅡB seminoma
died despite of salvage chemotherapy with RPLND. The remaining 3 patients with
residual mass were followed regulary without further treatment. They had no evidence
of recurrence which was evaluated by tumor marker, chest X-ray and abdominal CT.
The marked reduction of residual mass after adjuvant therapy were found in this group.
The overall survival rate in total patients was 98% at 5.75 years from initial diagnosis.
Conclusions : Adjuvant low-dose radiation therapy after radical orchiectomy was
recommended to reduce recurrence rates in stage Ⅰ seminoma. The vascular invasion,
pre-orchiectomy elevation of tumor markers, or pathologic T2 or more stage were risk
factors for relapse in stage Ⅰ NSGCT. In advanced staged germ cell tumor, high
survival rate was achieved by cis-platin based combination chemotherapy. Especially, in
the patients with marked reduction of tumor mass after chemotherapy, close surveillance
might be adequate in stead of second look operation for the retroperitoneal mass.
Irrelevant of its histopathologic finding and stage, the testicular germ cell tumor showed
excellent therapeutic end-results. Further studies should be directed at developing
therapeutic modalities that could achieve better therapeutic results with least therapeutic
complication and sequelae.
키워드
Testis; Germ cell tumor; Clinical characteristics; Prognostic factors;
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