一种新型白消安制备精原干细胞移植受体方法对小鼠生殖及生理功能的影响
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一种新型白消安制备精原干细胞移植受体方法对小鼠生殖及生理功能的影响
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3秒自动关闭窗口细胞:什么是动物的精原上皮细胞,生长在动物阴茎的什么部位?_百度作业帮
细胞:什么是动物的精原上皮细胞,生长在动物阴茎的什么部位?
指由睾丸精子管上皮的原始生殖细胞经过多次有丝分裂而形成的细胞.精原细胞属于雄性生殖细胞的早期发育阶段,能不断地进行细胞分裂,增加细胞数量,并分化为精母细胞．精原细胞描述：贴近基膜,细胞呈圆形,核大而圆,梁色深.精原细胞在男性的一生中具有几乎是无限分裂的能力,而且分裂过程中能够保持原有的基因性状不变,这是令人惊奇的!生殖精原细胞的增殖具有重要的生理意义.在增殖过程中,通过精原细胞的分裂和分化,由精原细胞产生精母细胞,进入成熟分裂,因而通过增殖可大大增加精母细胞的数量.按理论推算,一个精原细胞通过数次细胞分裂,可形成上百个初级精母细胞.但在生精过程早期,生精细胞很易发生变性,故实际上少于这个数字.在精原细胞的增殖过程中,有一部分Ad型精原细胞不再继续分裂,而是保留下来,成为新的精原干细胞,因此通过增殖不仅能使精原干细胞不断得到更新,且能使精原干细胞保持一定数量,从而使精子发生持续地进行下去,减数分裂和有性生殖细胞的形成
2C→4C& 分离& 4C→2C& 两& 2C→C?
g，那么在有丝分裂前期时，其骨髓细胞核中DNA重量为
四分体& 8& (2)减数第一分裂后& 初级精母细胞& 次级精母细胞& 2& 4&
(3)减数第二次分裂后& 次级卵母细胞& 卵细胞和第二极体& (4)1∶1& 2∶1
③同源染色体的形状和大小一般都相同& ④在减数分裂中配对的两条染色体
(2)次级精母& 极体& (3)4& 4
四分体& 8& (2)①和②、③和④& (3)4& 精子
］__________________。
］____________________。
］____________________。
］_____________。
8& 2& 1和2、3和4& 1和3、2和4或1和4、2和3
减数第一次分裂的分裂间期& ②& 减数第一次分裂前期& ⑤& 减数第一次分裂后期& ⑧&
减数第二次分裂后期
(２)ｅ→ｇ
同源染色体彼此分离，分别进入两个次级性母细胞或极体& 着丝点分开，染色单体分离分别进入两个子细胞
①& ④& (2)d& (3)b、c
8&& (2)如下图
(2)4，ABd、aBd、AbD、abD第一章 生殖细胞发生_百度文库
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【J Clin Oncol】F1000，JWatch一同推荐的好文献：播散性非精原生殖细胞肿瘤患者顺铂联合化疗的长期随访：完全缓解后是否需要行化疗后腹膜后淋巴结清扫术
【J Clin Oncol】F1000，JWatch一同推荐的好文献：播散性非精原生殖细胞肿瘤患者顺铂联合化疗的长期随访：完全缓解后是否需要行化疗后腹膜后淋巴结清扫术
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这个帖子发布于4年零349天前，其中的信息可能已发生改变或有所发展。
播散性非精原生殖细胞肿瘤患者顺铂联合化疗的长期随访：完全缓解后是否需要行化疗后腹膜后淋巴结清扫术Long-term follow-up of Cisplatin combination chemotherapy in patients with disseminated nonseminomatous germ cell tumors: is a postchemotherapy retroperitoneal lymph node dissection needed after complete remission?文献来源：JCO文献摘要：PURPOSE: Controversy arises regarding the optimal management of patients with nonseminomatous germ cell tumor (NSGCT) who achieve a serologic and radiographic complete remission (CR) to systemic chemotherapy. Some authors recommend postchemotherapy retroperitoneal lymph node dissection (PC-RPLND), whereas others omit surgery and observe these patients. In an attempt to address this question, we report the long-term follow-up of patients treated at Indiana University who were observed without PC-RPLND. PATIENTS AND METHODS: This is a retrospective analysis of patients with NSGCT who achieved a CR to first-line chemotherapy and were monitored without further therapy. CR was defined as normalization of serum tumor markers and resolution of radiographic disease (residual mass & 1 cm). RESULTS: One hundred forty-one patients were identified. Five patients (4%) had less than 2 years of follow-up. After a median follow-up of 15.5 years, 12 patients (9%) experienced relapse. Of these 12 patients, eight patients currently have no evidence of disease (NED), and four patients died of disease. The estimated 15-year recurrence-free survival (RFS) and cancer-specific survival rates were 90% and 97%, respectively. The estimated 15-year RFS for good-risk patients (n = 109) versus intermediate- or poor-risk patients (n = 32) was 95% and 73% (P = .001), respectively. Six patients (4%) experienced recurrence in the retroperitoneum, of whom two patients died of disease. Five patients had late relapse (range, 3 to 13 years), including two patients in the retroperitoneum. All five patients currently have NED. CONCLUSION: Patients obtaining a CR after first-line chemotherapy can be safely observed without PC-RPLND. Relapses are rare and potentially curable with further treatment.F1000专家推荐评语：Matthew MilowskyMemorial Sloane-Kettering Cancer Center, United States of America Oncology
This useful retrospective series of patients with nonseminomatous germ cell tumors (NSGCTs) who achieved a complete remission (CR) (normalization of tumor markers and residual mass &1cm) to first-line chemotherapy and were monitored without further therapy demonstrates the safety of observing them without a postchemotherapy retroperitoneal lymph node dissection (PC-RPLND). This strategy is particularly relevant to the treatment of patients outside of major referral centers. In patients with metastatic NSGCTs who achieve a serologic and radiographic remission to upfront chemotherapy, there is controversy regarding the recommendation for a PC-RPLND versus observation. This paper lends support to the safety of observing patients without a PC-RPLND, thereby sparing them the potential morbidity of surgery. This is most relevant to the management of patients outside of major referral centers, where RPLNDs are not routinely performed and may be less standardized and associated with increased morbidity. The authors performed a retrospective analysis of 141 patients with NSGCT from a center of excellence with a median follow up of 15.5 years. Twelve patients (9%) experienced relapse, with eight currently without disease and four dead from disease. This translates into a 15-year recurrence-free survival and cancer-specific survival rates of 90% and 97%, respectively. Only six patients experienced a relapse in the retroperitoneum and four died of disease. Relapse was more common in intermediate- or poor-risk patients. The authors make the point that the six retroperitoneal relapses (including two late relapses) would have been prevented with PC-RPLND; however, performing a PC-RPLND on all patients would have subjected 96% of patients to an unnecessary operation. Contrary to other studies, in this series, teratoma in the primary testicular histology did not lead to an increased risk of relapse. This paper presents a cogent argument for observation in the management of patients with NSGCT who achieve a CR to upfront chemotherapy. Patients must comply with the observation schedule and, in light of late relapses, they require long-term follow up. This supports a management strategy of observation for patients outside of major referral centers where RPLND expertise is not available and also supports observation as an alternative to RPLND in major referral centers. Future studies must focus on biomarkers that are able to predict those patients who are destined to relapse or require more or less aggressive therapy upfront. For further reading please see refs {1-5}. References: {1} Kollmannsberger et al. J Clin Oncol -42 [PMID:]. {2} Karellas et al. J Urol 7 (abstr 830). {3} Oldenburg et al. J Clin Oncol 0-7 [PMID:]. {4} Sharp et al. J Clin Oncol 4-9 [PMID:]. {5} Eggener et al. J Urol 7-42 [PMID:].JWatch点评文章：Treatment of Nonseminomatous Germ Cell Tumors
Management of patients with nonseminomatous germ cell tumors (NSGCTs) often involves both systemic chemotherapy and surgical resection — in most cases, retroperitoneal lymph node dissection (RPLND). Given high cure rates achieved in patients who have good- and intermediate-risk NSGCTs (using the International Germ Cell Cancer Collaborative Group risk classification system), efforts have focused on lowering therapy-related morbidity without compromising cure rates. Toward this end, two groups of investigators conducted retrospective studies to assess whether surveillance (instead of RPLND) after chemotherapy is safe in patients who achieve complete clinical responses to chemotherapy.
In one study, investigators reported outcomes of 141 patients with NSGCTs who experienced complete responses after chemotherapy, defined as normalization of serum tumor markers and resolution of radiographic disease (residual mass &1 cm). After median follow-up of &15 years, 12 patients (9%) experienced relapses. Of these, eight successfully underwent salvage therapy and are without evidence of disease (median follow-up after relapse, 11 years); four patients died from progressive NSGCTs. The estimated 15-year recurrence-free survival and cancer-specific survival rates were 90% and 97%, respectively.
In the second study, 10 of 161 patients (6%) with NSGCTs who initially responded to chemotherapy relapsed (response was defined as normalization of elevated tumor markers and residual disease 1 cm). All patients are still alive after median follow-up of 52 months, including patients who relapsed and were treated with RPLND (for teratoma) or salvage chemotherapy (median follow-up after recurrence, 64 months).
Comment: As editorialists note, both surveillance and RPLND remain standard options in patients who achieve complete clinical responses after chemotherapy. Clinicians and patients who are considering surveillance should take into account growing concerns about computed tomography imaging and associated radiation exposure (JW Emerg Med Jan 22 2010), which could be significant over time, given that most patients with NSGCTs are young when they have their diseases diagnosed. Patients who have good-risk tumors without teratomas might be the best candidates for surveillance.JWatch文章中提到的另外两篇文章：Kollmannsberger C et al. Management of disseminated nonseminomatous germ cell tumors with risk-based chemotherapy followed by response-guided postchemotherapy surgery. J Clin Oncol 2010 Feb 1; 28:537.Bosl GJ and Motzer RJ. Weighing risks and benefits of postchemotherapy retroperitoneal lymph node dissection: Not so easy. J Clin Oncol 2010 Feb 1; 28:519.
回复：【J Clin Oncol】F1000，JWatch一同推荐的好文献：播散性非精原生殖细胞肿瘤患者顺铂联合化疗的长期随访：完全缓解后是否需要行化疗后腹膜后淋巴结清扫术
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回复：【J Clin Oncol】F1000，JWatch一同推荐的好文献：播散性非精原生殖细胞肿瘤患者顺铂联合化疗的长期随访：完全缓解后是否需要行化疗后腹膜后淋巴结清扫术
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播散性非精原生殖细胞肿瘤患者顺铂联合化疗的长期随访：完全缓解后是否需要行化疗后腹膜后淋巴结清扫术Long-term follow-up of Cisplatin combination chemotherapy in patients with disseminated nonseminomatous germ cell tumors: is a postchemotherapy retroperitoneal lymph node dissection needed after complete remission?文献来源：JCO文献摘要：PURPOSE: Controversy arises regarding the optimal management of patients with nonseminomatous germ cell tumor (NSGCT) who achieve a serologic and radiographic complete remission (CR) to systemic chemotherapy. Some authors recommend postchemotherapy retroperitoneal lymph node dissection (PC-RPLND), whereas others omit surgery and observe these patients. In an attempt to address this question, we report the long-term follow-up of patients treated at Indiana University who were observed without PC-RPLND. 目的：关于非精原生殖细胞肿瘤（NSGCT）患者在血清和放射照相完全恢复到血清化疗后的最佳处理方式，出现了争论。一些作者推荐腹膜后淋巴结清扫术PC-RPLND，而其他人则推荐不做手术，观察病人。为了解决该问题，我们记录了长期随访印度大学没有接受PC-RPLND的病人的结果。PATIENTS AND METHODS: This is a retrospective analysis of patients with NSGCT who achieved a CR to first-line chemotherapy and were monitored without further therapy. CR was defined as normalization of serum tumor markers and resolution of radiographic disease (residual mass & 1 cm). 病人和方法：对NSGCT病人进行回顾分析，这些病人在一线药物化疗后完全恢复，在没有进一步治疗情况下进行监护。完全恢复（CR）定义为血清肿瘤标记物正常化，x透视消退（肿瘤残留& 1 cm）RESULTS: One hundred forty-one patients were identified. Five patients (4%) had less than 2 years of follow-up. After a median follow-up of 15.5 years, 12 patients (9%) experienced relapse. Of these 12 patients, eight patients currently have no evidence of disease (NED), and four patients died of disease. The estimated 15-year recurrence-free survival (RFS) and cancer-specific survival rates were 90% and 97%, respectively. The estimated 15-year RFS for good-risk patients (n = 109) versus intermediate- or poor-risk patients (n = 32) was 95% and 73% (P = .001), respectively. Six patients (4%) experienced recurrence in the retroperitoneum, of whom two patients died of disease. Five patients had late relapse (range, 3 to 13 years), including two patients in the retroperitoneum. All five patients currently have NED. 结果：受试者14人。5人（4%）随访时间少于2年。在15年半后的中期随访，12个病人病情出现过复发。在这12人中，8人目前没有明显病征（no evidence of disease ，NED），4人因病去世。评估的15年无复发存活率（RFS）90%，癌症存活率分别为97%。评估的15年情况较好的病人（n=109人）的RFS为95%，中度或情况较差病人的RFS为73%（P=0.01）。6人(4%)复发于腹膜后腔，其中2人因病死亡。5人后期复发（第3-13年间），包括2人复发于腹膜后腔。该5人均无明显病征。CONCLUSION: Patients obtaining a CR after first-line chemotherapy can be safely observed without PC-RPLND. Relapses are rare and potentially curable with further treatment.结论：病人在一线化疗后完全恢复后，没有做PC-RPLND的情况下，情况良好。在后期治疗中复发很少，有可能痊愈。F1000专家推荐评语：Matthew MilowskyMemorial Sloane-Kettering Cancer Center, United States of America OncologySloane-Kettering肿瘤纪念中心，美国肿瘤学会This useful retrospective series of patients with nonseminomatous germ cell tumors (NSGCTs) who achieved a complete remission (CR) (normalization of tumor markers and residual mass &1cm) to first-line chemotherapy and were monitored without further therapy demonstrates the safety of observing them without a postchemotherapy retroperitoneal lymph node dissection (PC-RPLND). This strategy is particularly relevant to the treatment of patients outside of major referral centers. In patients with metastatic NSGCTs who achieve a serologic and radiographic remission to upfront chemotherapy, there is controversy regarding the recommendation for a PC-RPLND versus observation.患有非精原细胞瘤型生殖细胞瘤病人，进行一线治疗后完全恢复（肿瘤标记物正常化，残留块小于1cm），而且没有实施进一步治疗。对于这些病人进行监控并进行的回顾说明，不进行腹膜后淋巴结清扫术的情况下观察病人是安全的。该策略与治疗病人的主要转诊中心特别相关。患有转移性NSGCTs的病人在化疗后，进行血清学和放射成像来缓解病情。进行观察还是推荐PC-RPLND成为争议。This paper lends support to the safety of observing patients without a PC-RPLND, thereby sparing them the potential morbidity of surgery. This is most relevant to the management of patients outside of major referral centers, where RPLNDs are not routinely performed and may be less standardized and associated with increased morbidity. The authors performed a retrospective analysis of 141 patients with NSGCT from a center of excellence with a median follow up of 15.5 years. Twelve patients (9%) experienced relapse, with eight currently without disease and four dead from disease. This translates into a 15-year recurrence-free survival and cancer-specific survival rates of 90% and 97%, respectively. Only six patients experienced a relapse in the retroperitoneum and four died of disease. 该文支持了不做PC-RPLND、观察病人是安全的，从而减少病人手术潜在死亡可能。这与管理转诊中心外的病人密切相关，因为转诊中心外RPLND不是常规治疗，可能不够规范，会增加死亡率。作者对优秀治疗中心141 个NSGCT病人进行了15年半随访的，完成了回顾分析。12人（9%）复发，8人目前没有患病，4人因病死亡。这些换算为数据即，15年无复发存活率90%，肿瘤患者存活率97%。仅有6人复发于腹膜后腔，其中4人因病死亡。Relapse was more common in intermediate- or poor-risk patients. The authors make the point that the six retroperitoneal relapses (including two late relapses) would have been prevented with PC-RPLND; however, performing a PC-RPLND on all patients would have subjected 96% of patients to an unnecessary operation. Contrary to other studies, in this series, teratoma in the primary testicular histology did not lead to an increased risk of relapse. This paper presents a cogent argument for observation in the management of patients with NSGCT who achieve a CR to upfront chemotherapy. Patients must comply with the observation schedule and, in light of late relapses, they require long-term follow up. This supports a management strategy of observation for patients outside of major referral centers where RPLND expertise is not available and also supports observation as an alternative to RPLND in major referral centers. Future studies must focus on biomarkers that are able to predict those patients who are destined to relapse or require more or less aggressive therapy upfront. For further reading please see refs {1-5}. 中度或者情况较差病人的复发往往更普遍。作者指出，6个腹膜后腔复发者（包括2个完全复发）应当进行PC-RPLND来进行保护；然而，对所有病人进行PC-RPLND会造成96%的病人进行不必要的手术。与其他研究不同，此次研究，在早期睾丸组织学检测到的畸胎瘤并没有增加复发的危险。该文给出了令人信服的观点，即对NSGCT患者在化疗后完全恢复后处理方式是进行观察。病人必须完全遵守观察日程，在晚期易复发阶段，应进行长期的随访。该观点支持了对不能获得有效的RPLND专家意见的主要转诊中心外的病人进行观察的管理策略，也支持了在主要转诊中心可以用观察替代RPLND。进一步的研究需要集中在能够预测会复发的病人、需要减弱或增强治疗的病人的生物标记物。需进一步了解，请见参考文献1-5References: {1} Kollmannsberger et al. J Clin Oncol -42 [PMID:]. {2} Karellas et al. J Urol 7 (abstr 830). {3} Oldenburg et al. J Clin Oncol 0-7 [PMID:]. {4} Sharp et al. J Clin Oncol 4-9 [PMID:]. {5} Eggener et al. J Urol 7-42 [PMID:].JWatch点评文章：Treatment of Nonseminomatous Germ Cell Tumors非精原细胞瘤型生殖细胞瘤的治疗Management of patients with nonseminomatous germ cell tumors (NSGCTs) often involves both systemic chemotherapy and surgical resection — in most cases, retroperitoneal lymph node dissection (RPLND). Given high cure rates achieved in patients who have good- and intermediate-risk NSGCTs (using the International Germ Cell Cancer Collaborative Group risk classification system)，efforts have focused on lowering therapy-related morbidity without compromising cure rates. Toward this end, two groups of investigators conducted retrospective studies to assess whether surveillance (instead of RPLND) after chemotherapy is safe in patients who achieve complete clinical responses to chemotherapy.对非精原细胞瘤型生殖细胞瘤患者的管理常常有两种方式：全身化疗和手术摘除--在大多数情况下是腹膜后淋巴结清除（RPLND）。针对获得高治愈率的状况良好或中度的病人（使用国际生殖细胞癌症共同组织风险等级分类系统），关注于降低治疗相关死亡率，不通过减低治愈率来实现。为了达此目的，两组研究者开展了回顾性研究来评估化疗后的监视（代替RPLND）是否对于化疗后恢复完全的病人是安全的。In one study, investigators reported outcomes of 141 patients with NSGCTs who experienced complete responses after chemotherapy, defined as normalization of serum tumor markers and resolution of radiographic disease (residual mass &1 cm). After median follow-up of &15 years, 12 patients (9%) experienced relapses. Of these, eight successfully underwent salvage therapy and are without evidence of disease (median follow-up after relapse, 11 years); four patients died from progressive NSGCTs. The estimated 15-year recurrence-free survival and cancer-specific survival rates were 90% and 97%, respectively.在一组研究中，研究者报道了化疗后完全恢复的141个NSGCT患者的结果。完全恢复定义为肿瘤标记物正常化和x透视消退（肿瘤残留& 1 cm）。在随访15多年后，12人（9%）复发。其中8人成功进行补救治疗，没有明显病征（复发后中期随访11年）；4人由于恶化的NSGCT死亡。评估的15年无复发存活率为90%，患肿瘤存活率97%。In the second study, 10 of 161 patients (6%) with NSGCTs who initially responded to chemotherapy relapsed (response was defined as normalization of elevated tumor markers and residual disease 1 cm). All patients are still alive after median follow-up of 52 months, including patients who relapsed and were treated with RPLND (for teratoma) or salvage chemotherapy (median follow-up after recurrence, 64 months).在第二个研究中，161个化疗有效的NSGCT病人（有效的定义为肿瘤标记物正常化和肿瘤残留& 1 cm），其中10个（6%）复发。所有病人在中期随访52个月后依旧存活，包括复发后采用RPLND（用于治疗畸胎瘤）治疗的病人，或者补救化疗的病人（复发后中期随访64个月）。Comment: As editorialists note, both surveillance and RPLND remain standard options in patients who achieve complete clinical responses after chemotherapy. Clinicians and patients who are considering surveillance should take into account growing concerns about computed tomography imaging and associated radiation exposure (JW Emerg Med Jan 22 2010), which could be significant over time, given that most patients with NSGCTs are young when they have their diseases diagnosed. Patients who have good-risk tumors without teratomas might be the best candidates for surveillance.评论: 如作者所说，监视和RPLND治疗依旧都是病人在化疗后完全恢复之后的标准选择。考虑采用监视的临床医生和病人，应该考虑用计算机化的断层摄影成像术和相关的射线照射法(JW Emerg Med Jan 22 2010)关注肿瘤生长，该方法随时间推移效果明显，可以在大多数病人NSGCT初发时诊断出。患有良性肿瘤且无畸胎瘤的病人是进行监视的最好候选者。JWatch文章中提到的另外两篇文章：Kollmannsberger C et al. Management of disseminated nonseminomatous germ cell tumors with risk-based chemotherapy followed by response-guided postchemotherapy surgery. J Clin Oncol 2010 Feb 1; 28:537.Bosl GJ and Motzer RJ. Weighing risks and benefits of postchemotherapy retroperitoneal lymph node dissection: Not so easy. J Clin Oncol 2010 Feb 1; 28:519
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回复：【J Clin Oncol】F1000，JWatch一同推荐的好文献：播散性非精原生殖细胞肿瘤患者顺铂联合化疗的长期随访：完全缓解后是否需要行化疗后腹膜后淋巴结清扫术
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播散性非精原生殖细胞肿瘤患者顺铂联合化疗的长期随访：完全缓解后是否需要行化疗后腹膜后淋巴结清扫术文献来源：JCO文献摘要：目的：关于非精原生殖细胞肿瘤（NSGCT）患者在血清和放射照相完全恢复到血清化疗后的最佳处理方式，出现了争论。一些作者推荐腹膜后淋巴结清扫术PC-RPLND，而其他人则推荐不做手术，观察病人。为了解决该问题，我们记录了长期随访印度大学没有接受PC-RPLND的病人的结果。病人和方法：对NSGCT病人进行回顾分析，这些病人在一线药物化疗后完全恢复，在没有进一步治疗情况下进行监护。完全恢复（CR）定义为血清肿瘤标记物正常化，x透视消退（肿瘤残留& 1 cm）结果：受试者14人。5人（4%）随访时间少于2年。在15年半后的中期随访，12个病人病情出现过复发。在这12人中，8人目前没有明显病征（no evidence of disease ，NED），4人因病去世。评估的15年无复发存活率（RFS）90%，癌症存活率分别为97%。评估的15年情况较好的病人（n=109人）的RFS为95%，中度或情况较差病人的RFS为73%（P=0.01）。6人(4%)复发于腹膜后腔，其中2人因病死亡。5人后期复发（第3-13年间），包括2人复发于腹膜后腔。该5人均无明显病征。结论：病人在一线化疗后完全恢复后，没有做PC-RPLND的情况下，情况良好。在后期治疗中复发很少，有可能痊愈。F1000专家推荐评语：Matthew MilowskyMemorial Sloane-Kettering Cancer Center, United States of America OncologySloane-Kettering肿瘤纪念中心，美国肿瘤学会患有非精原细胞瘤型生殖细胞瘤病人，进行一线治疗后完全恢复（肿瘤标记物正常化，残留块小于1cm），而且没有实施进一步治疗。对于这些病人进行监控并进行的回顾说明，不进行腹膜后淋巴结清扫术的情况下观察病人是安全的。该策略与治疗病人的主要转诊中心特别相关。患有转移性NSGCTs的病人在化疗后，进行血清学和放射成像来缓解病情。进行观察还是者推荐PC-RPLND成为争议。该文支持了不做PC-RPLND，观察病人是安全的，从而减少病人手术潜在死亡可能。这与管理转诊中心外的病人密切相关。因为转诊中心外RPLND不是常规治疗，可能不够规范，会增加死亡率。作者对优秀治疗中心141 个NSGCT病人进行了15年半随访的，完成了回顾分析。12人（9%）复发，8人目前没有患病，4人因病死亡。这些换算为数据即，15年无复发存活率90%，肿瘤患者存活率97%。仅有6人复发于腹膜后腔，其中4人因病死亡。中度或者情况较差病人的复发往往更普遍。作者指出，6个腹膜后腔复发者（包括2个完全复发）应当进行PC-RPLND来进行保护；然而，对所有病人进行PC-RPLND会造成96%的病人进行不必要的手术。与其他研究不同，此次研究，在早期睾丸组织学检测到的畸胎瘤并没有增加复发的危险。该文给出了令人信服的观点，即对NSGCT患者在化疗后完全恢复后处理方式是进行观察。病人必须完全遵守观察日程，在晚期易复发阶段，应进行长期的随访。该观点支持了对不能获得有效的RPLND专家意见的主要转诊中心外的病人进行观察的管理策略，也支持了在主要转诊中心可以用观察替代RPLND。进一步的研究需要集中在能够预测会复发的病人、需要减弱或增强治疗的病人的生物标记物。需进一步了解，请见参考文献1-5References: {1} Kollmannsberger et al. J Clin Oncol -42 [PMID:]. {2} Karellas et al. J Urol 7 (abstr 830). {3} Oldenburg et al. J Clin Oncol 0-7 [PMID:]. {4} Sharp et al. J Clin Oncol 4-9 [PMID:]. {5} Eggener et al. J Urol 7-42 [PMID:].JWatch点评文章：Treatment of Nonseminomatous Germ Cell Tumors非精原细胞瘤型生殖细胞瘤的治疗对非精原细胞瘤型生殖细胞瘤患者的管理常常有两种方式：全身化疗和手术摘除--在大多数情况下是腹膜后淋巴结清除（RPLND）。针对获得高治愈率的状况良好或中度的病人（使用国际生殖细胞癌症共同组织风险等级分类系统），关注于降低治疗相关死亡率，不通过减低治愈率来实现。为了达此目的，两组研究者开展了回顾性研究来评估化疗后的监视（代替RPLND）是否对于化疗后恢复完全的病人是安全的。在第一个研究中，研究者报道了化疗后完全恢复的141个NSGCT患者的结果。完全恢复定义为肿瘤标记物正常化和x透视消退（肿瘤残留& 1 cm）。在随访15多年后，12人（9%）复发。其中8人成功进行补救治疗，没有明显病征（复发后中期随访11年）；4人由于恶化的NSGCT死亡。评估的15年无复发存活率为90%，患肿瘤存活率97%。在第二个研究中，161个化疗有效的NSGCT病人（有效的定义为肿瘤标记物正常化和肿瘤残留& 1 cm），其中10个（6%）复发。所有病人在中期随访52个月后依旧存活，包括复发后采用RPLND（用于治疗畸胎瘤）治疗的病人，或者补救化疗的病人（复发后中期随访64个月）。评论: 如作者所说，监视和RPLND治疗依旧都是病人在化疗后完全恢复之后的标准选择。考虑采用监视的临床医生和病人，应该考虑用计算机化的断层摄影成像术和相关的射线照射法(JW Emerg Med Jan 22 2010)关注肿瘤生长，该方法随时间推移效果明显，可以在大多数病人NSGCT初发时诊断出。患有良性肿瘤且无畸胎瘤的病人是进行监视的最好候选者。JWatch文章中提到的另外两篇文章：Kollmannsberger C et al. Management of disseminated nonseminomatous germ cell tumors with risk-based chemotherapy followed by response-guided postchemotherapy surgery. J Clin Oncol 2010 Feb 1; 28:537.Bosl GJ and Motzer RJ. Weighing risks and benefits of postchemotherapy retroperitoneal lymph node dissection: Not so easy. J Clin Oncol 2010 Feb 1; 28:519
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