睾丸腫瘍の臨床的観察

Abstract

成人原発性睾丸腫瘍症例31例について検討した.1)病期別, 病理組織別に分類した結果セミノーマ群は17例でstage 1が13例, stage 2が4例であった.またNSGCT (nonseminomatous germ cell tumor)群は14例でstage 1が8例, stage 2が1例, stage 3が5例であった.2)セミノーマ群の予後は良好で癌死はなく, とくにstage 1および2aは放射線療法で治癒が期待できる.stage 2b以上は化学療法およびRPLND(後腹膜リンパ節廓清術)が必要と考えられ, 化学療法後の残存腫瘍に対しても積極的な手術療法が有効である.3) NSGCT群においてstage 1の予後は良くRPLNDと化学療法でほぼ全例にCRが望め, stage 2bおよび3の進行例には, まず化学療法を行い, ついで縮小した転移巣に対しての手術療法を施行し, その後再び化学療法によって治療することなどによる集学的治療方法によって予後の向上が得られるものと考える

Thirty-one patients with testicular germ cell tumors were treated in our Department between January, 1979 and June, 1987. Of the 31 patients, 17 (54.8%) had seminoma and 14 (45.2%) had non-seminomatous germ cell tumor (NSGCT) histopathologically. Clinical stage of seminoma was stage I in 13 patients (76.5%) and stage II in 4 patients (23.5%). Clinical stage of NSGCT was stage I in 8 patients (57.2%), stage II in 1 patient (7.1%) and stage III in 5 patients (35.7%). The patients with stage II seminoma underwent high inguinal orchiectomy, radiation therapy, retroperitoneal lymphnode dissection (RPLND) and chemotherapy, and those with stage II and III NSGCT underwent high inguinal orchiectomy and chemotherapy. All patients with stage II seminoma are alive with no evidence of disease. Three patients with stage II and III NSGCT are alive with no evidence of disease, but 3 patients died of the disease. Survival of patients with stage I and II seminoma at 5 years was 100% Survival of stage I and II NSGCT and III NSGCT at 5 years was 100% and 40%, respectively. According to our experience, for patients with advanced seminoma, combination chemotherapy and RPLND as well as radiation therapy are effective. In addition, for patients with advanced NSCGT, adjuvant chemotherapy followed by RPLND is effective.