ASCO 2018前瞻之一：蛋蛋的忧伤

橙色雨丝

Primary testicular lymphoma: Treatment patterns and survival of 1740 men from the National Cancer Database.

Abstract:

Background: The standard of care (SOC) for primary testicular lymphoma (PTL) is orchiectomy, chemotherapy (CHT) and radiation (RT) of the contralateral testis regardless of stage. PTL is rare and usually presents in elderly men; we hypothesized that men may not receive SOC and may have worse outcomes. To assess this, we queried the National Cancer Database (NCDB) which includes 70% of newly diagnosed US cancers, to analyze treatment patterns and survival of men with PTL in the rituximab era.

Methods: Using NCDB data (2006 to 2013), we searched for men diagnosed with extra nodal lymphoma (N = 109210), primary site testis (N = 1865). Patients were analyzed in 2 treatment groups: 1) CHT + RT (SOC group); and 2) CHT alone, RT alone and orchiectomy alone, grouped as no-SOC. Kaplan-Meier (KM) survival plots were used to investigate 5-year overall survival (OS). Log rank test was used to estimate survival differences between treatments.

Results: 1740 men with PTL underwent orchiectomy. Median age was 69. 794 (45.6%) were Stage 1, 217 (12.5%) were Stage 2, 88 (5.1%) were Stage 3, 274 (15.7%) were Stage 4. 367 men (21.1%) had no staging information available and were not included in the survival analysis. 619 (35.5%) received SOC, 692 (39.8%) had CHT alone, 54 (3.1%) had RT alone, and 375 (21.6%) received no further treatment. KM analysis by stage (Table 1) showed 5-year OS was significantly higher in the SOC group vs.non-SOC for Stage 1 (83.8% vs. 66.1%, p < 0.001), Stage 2 (78.2% vs. 58.7%, p = 0.003) and Stage 4 (64.3% vs. 54.5%, p = 0.001). Stage 3 patients receiving SOC had a non-significant trend toward survival advantage (74.1% vs 60.7%, p = 0.07).

Conclusions: This study represents the largest PTL cohort reported to date and is reflective of current treatments. These data show that most US PTL patients do not receive guideline-recommended SOC, and OS is significantly worse across stages for those that do not receive SOC, highlighting the need for improved management of PTL.

橙色雨丝

原发睾丸淋巴瘤并不常见，所以作者从美国国家癌症数据库里找出1740个病例进行分析很不容易。一个意外的发现就是，只有三分之一左右的患者接受了指南中推荐的标准治疗（切除+化疗+放疗），而这部分患者无论分期如何，在生存期上比未接受标准治疗的患者有显著优势（大约15个百分点），再次提示“规范治疗”的重要性。

敦煌学

以为是英语考试题

原发性睾丸淋巴瘤:国家癌症数据库1740名患者的治疗模式和生存状况。

敦煌学

女生看了 记3分罚款200

拥抱太阳

科普任重道远！再次提示“规范治疗”的重要性。

美佳

橙色雨丝 发表于 2018-5-20 15:14
原发睾丸淋巴瘤并不常见，所以作者从美国国家癌症数据库里找出1740个病例进行分析很不容易。一个意外的发现 ...

雨丝大神您好，这里提出的切除是两侧全切还是只是患病侧切除。

橙色雨丝

美佳 发表于 2019-1-16 12:09
雨丝大神您好，这里提出的切除是两侧全切还是只是患病侧切除。

患侧切除，对侧放疗。

美佳

橙色雨丝 发表于 2019-1-16 13:15
患侧切除，对侧放疗。

谢谢您

Yuanpingan

@橙色雨丝 雨丝大神，我们切除了患侧，但是petct显示对侧也被浸润了。应该把对侧也切了吗？？

我们现在是生发中心，Bcl2、cmyc双表达，ki67 70%，cd5灶+，p53散在+，fish检测cmyc阴性，化疗前petct只提示对侧fdg代谢高。医生定的治疗方案是rchop+鞘注+大剂量mtx+放疗，这样会不会太轻了啊？如果没有切除被浸润的对侧是不是不算完成标准治疗了啊？

另外还想请问，我们需要把白片送去检测一下myd88、cd79b、cd5、p53有没有基因突变，提示预后吗？

我搜了很多睾丸淋巴瘤的资料，预后极差，容易复发，所以希望初治能很顺利地cr。后面再慢慢攒钱应对可能到来的复发。

橙色雨丝

Yuanpingan 发表于 2020-11-10 10:56
@橙色雨丝 雨丝大神，我们切除了患侧，但是petct显示对侧也被浸润了。应该把对侧也切了吗？？

我们现在是 ...

是不是有必要再切，恐怕还是要看具体情况。方案一点也不轻，大剂量甲氨蝶呤能耐受下来就不容易。基因检测可以做一下，不过对治疗药物的选择影响不大。

Yuanpingan

橙色雨丝 发表于 2020-11-10 11:27
是不是有必要再切，恐怕还是要看具体情况。方案一点也不轻，大剂量甲氨蝶呤能耐受下来就不容易。基因检测 ...

具体情况是指四疗后有没有cr吗？我很怕血睾屏障的存在，直接就通过对侧进入神经中枢了。我们上周六第一次化疗没有鞘注，第二次也不知道要不要鞘注。

宽宽

Yuanpingan 发表于 2020-11-10 10:56
@橙色雨丝 雨丝大神，我们切除了患侧，但是petct显示对侧也被浸润了。应该把对侧也切了吗？？

我们现在是 ...

我父亲20年前得的睾丸原发淋巴癌，在协和切除一侧睾丸后标准治疗后痊愈。现在中枢复发了。

土豆番茄

橙色雨丝 发表于 2018-5-20 15:14
原发睾丸淋巴瘤并不常见，所以作者从美国国家癌症数据库里找出1740个病例进行分析很不容易。一个意外的发现 ...

请问大神，我爸睾丸淋巴瘤分期3期，放疗是否有意义？放疗医生都说放疗对一期二期的睾丸淋巴瘤有意义，我们3期没意义，哎，都不知道要不要放疗

橙色雨丝

土豆番茄 发表于 2021-5-25 10:18
请问大神，我爸睾丸淋巴瘤分期3期，放疗是否有意义？放疗医生都说放疗对一期二期的睾丸淋巴瘤有意义，我 ...

需要根据具体情况分析。