非セミノーマ精巣腫瘍の臨床的検討

Abstract

非セミノーマ精巣腫瘍26例につき, 組織分類はembryonal carcinoma 7例, teratoma 4例, yolk sac tumor 2例, teratocarcinoma 10例, その他複合組織型3例であった.初診時Stageは1 18例, 2A, 2B各1例, 3A 1例, 3B1 2例, 3B2 3例で, 治療はStage 1は高位除睾術のみ, 転移巣あるStage 2B以上の症例には主にPVB療法で, CR, PR, PD各2例であった.Stage 1の2/5例は再発を認め, 未分化teratomaの成分を含んでいた.腫瘍マーカーAFPは20, HCGは18の症例で上昇していた.進行例のLDH上昇率が高かった.22例は5年生存をなしとげた

We treated 26 patients with nonseminomatous germ cell tumors (NSGCT) between January 1976 and March 1989. Histologically, 7 were embryonal carcinoma (27%), 4 were teratoma (15%), 2 were yolk sac tumor (8%), 10 were teratocarcinoma (38%) and 3 were other mixed tumors. As regards staging, 18 belonged to stage I (69%), 1 to stage II A (4%), 1 to stage IIB (4%), 1 to stage IIIA, 2 to stage III B1 (8%) and 3 to stage III B2 (12%). Patients in stage I were treated by orchidectomy with lymphadenectomy and occasionally chemotherapy before 1984, resulting in a 100% 5-year survival. However, after 1985, 5 cases in stage I were treated by orchidectomy alone according to a watch-and-see policy. Two cases among them relapsed within two years and both of them contained immature teratoma elements. Six patients with metastatic tumor were treated with PVB therapy of which response rate was 66.7%. The total 5-year survival rate of patients in stage I, II and III was 100%, 50%, 50%, respectively and that in overall cases was 84.6%.