Objective To analyze the clinical characteristics and outcomes of children with stage Ⅰ testicular germ cell tumors (TGCT),and to discuss the treatment strategy for this disease after radical inguinal orchiectomy.Methods Clinical data of 41 patients with stage Ⅰ TGCT at Shanghai Children's Medical Center,Shanghai Jiaotong University School of Medicine between June 2003 to December 2013 were retrospectively analyzed.Their clinical characteristics,therapy and outcomes were analyzed.Results (1) The median age at diagnosis was 18 (3 to 43) months old.Among them,38 children(92.7％) were younger than 3 years old.The pathological subtype included 35 cases of yolk sac (85.4％),4 immature teratoma (9.7％) and 2 mixed germ cell tumors (4.9％).(2) Serum AFP levels were elevated in 38 patients (92.7％).AFP reduced to normal in 27 cases(71.1％)4 weeks after surgery and in 35 cases(92.1％) after 2 courses of chemotherapy respectively,but 2 cases of them relapsed with AFP increasing again.(3)Forty out of 41 patients underwent surgery and 3 ～ 4 courses of chemotherapy with cyclophosvnamide,vincristine and dactinomycin D (VAC).One patient received surgery alone.The median follow-up period was 64 months.One of the 32 patients who received adjuvant chemotherapy relapsed and then lost follow-up without treatment.The recurrence rate was 3.1％ and the 5-year overall survival was 100％.No complication related to chemotherapy occurred during the follow-up.The only one patient treated with surgery alone relapsed at 5 months and achieved complete response after salvage treatment.Conclusion (1) The relationship between the decrease of serum AFP and the prognosis is uncertain and needs to be further studied.(2) Short course chemotherapy with mild toxic side effects can reduce the recurrence rate effectively,so it can be used as a necessary treatment for patients with high risk of relapse,and it can also be used as a selective treatment for patients with low risk of recurrence.%目的 分析儿童Ⅰ期睾丸生殖细胞肿瘤(TGCT)的临床特点和远期随访效果,并对肿瘤根治术后的治疗方案进行初步探讨.方法 回顾性分析上海交通大学医学院附属上海儿童医学中心2003年6月至2013年12月收治的41例Ⅰ期TGCT患儿的临床资料,讨论其临床特点、治疗方法及疗效.结果 (1)41例TGCT患儿诊断时的中位年龄为18个月(3～43个月),其中＜3岁者38例(92.7％).病理亚型为卵黄囊瘤35例(85.4％),未成熟畸胎瘤4例(9.7％),恶性混合性生殖细胞瘤者2例(4.9％).(2)术前血清甲胎蛋白(AFP)升高者38例(92.7％).术后4周及术后2个疗程化疗后AFP降至正常者分别为27例(71.1％)及35例(92.1％),2例出现复发,均伴有AFP再次升高.(3)41例患儿中40例术后接受3～4个疗程的长春新碱+更生霉素+环磷酰胺(VAC)方案化疗.1例术后仅予定期随访.按期随访者33例,中位随访时间64个月.术后接受化疗并按期随访的32例患儿中1例出现复发,家长拒绝治疗后失访.复发率为3.1％,5年总生存率为100％.随访期内无化疗相关并发症发生.术后未予化疗的1例患儿随访过程中出现肺部转移性复发,给予化疗后随访至今99个月完全缓解.结论 (1)血清AFP的下降情况与预后之间的关系尚不确定,有待进一步研究.(2)术后低强度短程化疗后复发率低且毒副反应小,可作为高复发风险患者的必要治疗,亦可作为低复发风险患者的选择性治疗措施.
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