睾丸生殖细胞肿瘤伴静脉肿瘤血栓：患病率、表现及管理

关于表现有静脉肿瘤血栓（VTT）的睾丸生殖细胞肿瘤（TGCT）病例的患病率和管理策略的资料有限。我们的目标是描述TGCT伴VTT的患病率，建立多中心回顾性队列，并征求专家对于该病理状态的最佳管理意见。利用IBM Marketscan数据库，我们识别了接受腹膜后淋巴结清扫术（RPLND）且伴有VTT或下腔静脉（IVC）肿瘤血栓切除术的男性患者，以估算TGCT中VTT的患病率。为建立多中心回顾性队列，我们调查了外科医生，描述了患者的临床表现、管理策略及预后。根据严格或宽松的标准，IBM Marketscan数据库中TGCT伴VTT的患病率分别为0.3%（n=7/2517）和3.1%（n=79/2517）。在我们的调查中，来自十个中心的16名外科医生提供了34名患者的数据。大多数患者（n=29，85%）表现为非精原细胞瘤。手术治疗的比例为93.9%（n=31），其中63%的患者接受了化疗后肿瘤血栓切除术伴原发腔静脉缝合。由于数据库仅限于有保险的患者，且未包括临床病理细节，账单编码可能包括间质瘤患者。此外，匿名调查未能提供全部数据，RedCap调查也未涉及IVC阻塞的特定症状，且无法对影像进行集中评审以确认VTT诊断。TGCT患者中VTT罕见，需复杂的多学科管理，包括化疗后RPLND时进行静脉肿瘤血栓切除。通过医疗数据库估算，睾丸癌扩展到血管中的肿瘤（VTT）发生率仅为0.3%-3.1%。调查结果显示，虽然睾丸癌对化疗反应良好，但VTT的反应较差，且该罕见情况需要复杂手术治疗。

There are limited data on the prevalence and management of testicular germ cell tumor (TGCT) cases presenting with venous tumor thrombus (VTT). Our objectives were to describe the prevalence of TGCT with VTT, to identify a multicenter retrospective cohort, and to ascertain expert opinion regarding optimal management of this entity.Using the IBM Marketscan database, we identified men with testicular cancer who underwent retroperitoneal lymph node dissection (RPLND) with concurrent VTT or inferior vena cava (IVC) tumor thrombectomy to estimate the prevalence of VTT in TGCT. To identify a multicenter retrospective cohort of patients, we surveyed surgeons and described the presentation, management, and outcomes for the cohort.The prevalence of TGCT with VTT in the IBM Marketscan database was 0.3% (n = 7/2517) when using stringent criteria and 3.1% (n = 79/2517) when using broad criteria. In response to our survey, 16 surgeons from ten centers contributed data for 34 patients. Most patients (n = 29, 85%) presented with nonseminomatous germ cell tumor. Surgical management was used for 93.9% (n = 31), including postchemotherapy tumor thrombectomy with primary cavorrhaphy in 63%. The Marketscan analysis was limited to insured individuals and did not include clinicopathological details, and use of billing codes may have included patients with stromal tumors. In addition, lack of responses to the anonymous survey limited data capture, and the RedCap survey did not address symptoms specific to IVC obstruction or allow central review of the imaging leading to VTT diagnosis.VTT among males with TGCT is rare and requires complex multidisciplinary management, including venous tumor thrombectomy at the time of postchemotherapy RPLND.Using a medical database, we estimated that the frequency of testicular cancer cases in which the tumor extends into a blood vessel (called venous tumor thrombus, VTT) is just 0.3-3.1%. We carried out a survey of surgeons with experience of this condition. Our results indicate that although testicular cancers respond well to chemotherapy, VTT is less responsive and complex surgery is necessary for this rare condition.