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睾丸癌的关键进展:优化生存质量与生存期

Key Updates in Testicular Cancer: Optimizing Survivorship and Survival.

作者信息

Bagrodia Aditya, Haugnes Hege Sagstuen, Hellesnes Ragnhild, Dabbas Mai, Millard Fred, Nappi Lucia, Daneshmand Siamak, Kollmannsberger Christian, Einhorn Lawrence H

机构信息

Department of Urology and Radiation Medicine, UC San Diego School of Medicine, La Jolla, CA.

Department of Urology, UT Southwestern Medical Center, Dallas, TX.

出版信息

Am Soc Clin Oncol Educ Book. 2025 Jun;45(3):e472654. doi: 10.1200/EDBK-25-472654. Epub 2025 May 5.

Abstract

Testicular cancer is a rare but highly curable malignancy, predominantly affecting young men. Advances in multimodal therapy, including cisplatin-based chemotherapy, radiotherapy, and surgical interventions, have resulted in excellent cancer-specific survival. However, with improved survival rates, long-term health consequences and survivorship issues have emerged as critical concerns. Testicular cancer survivors (TCSs) are at risk of adverse health outcomes, including endocrine dysfunction, cardiovascular disease, secondary malignancies, chemotherapy-induced neuropathy, and psychosocial challenges. Endocrine disturbances such as hypogonadism and infertility require careful monitoring, while cardiovascular risks necessitate long-term preventive strategies. Survivors also face an elevated risk of secondary malignancies, necessitating tailored follow-up. Recent advances in the de-escalation of therapy, particularly for stage II seminoma and metastatic germ cell tumors, aim to balance oncologic efficacy with minimizing toxicity. This review discusses the evolving landscape of testicular cancer survivorship, the impact of treatment-related complications, and contemporary management strategies, emphasizing a multidisciplinary approach to optimize long-term outcomes and quality of life.

摘要

睾丸癌是一种罕见但治愈率很高的恶性肿瘤,主要影响年轻男性。多模式治疗的进展,包括以顺铂为基础的化疗、放疗和手术干预,已带来了出色的癌症特异性生存率。然而,随着生存率的提高,长期健康后果和生存问题已成为关键关注点。睾丸癌幸存者(TCSs)面临不良健康结局的风险,包括内分泌功能障碍、心血管疾病、继发性恶性肿瘤、化疗引起的神经病变以及心理社会挑战。诸如性腺功能减退和不育等内分泌紊乱需要仔细监测,而心血管风险则需要长期预防策略。幸存者还面临继发性恶性肿瘤风险升高的问题,因此需要进行针对性的随访。治疗方案降级方面的最新进展,特别是对于II期精原细胞瘤和转移性生殖细胞肿瘤,旨在平衡肿瘤学疗效与毒性最小化。本综述讨论了睾丸癌生存领域的不断演变、治疗相关并发症的影响以及当代管理策略,强调采用多学科方法来优化长期结局和生活质量。

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