| Objective Through studying the clinical data of the diagnosis and treatment of testicular tumor and these patients' qualities of life in West China Hospital of Sichuan University during the past 35 years, to find out the component trends of the disease, summarize the evolvement of diagnosis and treatment of the disease, discuss the method how to prophylaxis, detect as soon as possible and treat the disease and to improve the patients' qualities of life. Data and Method: There are 23587 cases reviewed with standard survey tables, which were hospitalized to urological department of West China Hospital of Sichuan University from Jan. 1969 to Oct. 2003.Inclusion criteria: the patients suffering testicular tumor;Exclusion criteria: the incomplete medical records.There are 220 cases selected in total 23587 cases according to the above standards and according to the classified standard these 220cases were assigned into 9 subgroups: (Dseminoma; ?embryonic cell cancer; ?yolk sac tumor; ?teratoma; ?chorionic epithelioma; ?mixed germ cell tumor; ?Gonadal hypothallus tumor; ?others;. (Dunclassified. According to the etiological factors, these cases were also classified into cryptorchidism group and non- cryptorchidism group. The 35 years were separated into 3 periods: 70's (1969- 1980); 80's (1981-1990); 90's (1991-2003). Through calculating the average, proportion, median and ratio of these collected cases, we could analysis and statistize testicular tumor's tendency and variation etc. to get some useful information to guide our clinic. Results In 70's, 80's and 90's, the number of average patients per annum respectively is 252.8,457.3 and 1248.7; the average hospitalization rate per annum respectively is 0.86%, 1.49% and 0.79%. Among the diseases, the case number of germinoma is 176, 85.9%. in particular, seminoma is 111, 50.5%; the cases number (and constituent ratio) of seminoma respectively are 12(50%), 37(54.5), 62(48.4%), these data show a raised trend. Embryonic cell cancer is 17, 7.7%, and the cases number (and constituent ratio) of the cancer each are 1(4.2%), 2(2.9%), 14(10.9%), the data show a raised tend. In the patients' medical histories, there are 58 cases having cryptorchidism, 26.4%, 25 cases having left cryptorchidism, 26 right cryptorchidism, particularly in 80's the right is more than the left. Among the cryptorchidism, seminoma is 35, 60.35%; yolk sac tumor, chorionic epithelioma and gonadal hypothallus tumor are all 0; mixed germ cell tumor is 5, 8.62%, compared with non- cryptorchidism, the differenceis notable. The episode age(median) in every subgroups each is: seminoma, 39.8; embryonic cell cancer, 36; yolk sac tumor, 8.9; teratoma, 7.8; gonadal hypothallus tumor, 58. Among the component of different episode age-period, the episode age of seminoma less than 20 is 0, the age is relatively centralized on between 21 and 50; teratoma is in opposite; yolk sac tumor centralizes in 20; chorionic epithelioma centralizes between 21 and 30; mixed germ cell tumor centralizes in 50. The differences in each of age-period subgroups are all notable. In different age the cases number and ratio of identical age patients show a raised trend. In 70's, the episode age centralizes between 31 and 50, and no patients are beyond 60. The differences of component of different age are notable; In 80's, the age is centralized between 31 and 40, and has a average trend. The differences are notable, but less marked than those in 70's. In 90's, the number between 21 and 30 is more than that between 31 and 40, the ratio of patients beyond 60 increased continuingly, the differences are notable, but the differences decreased continuingly, they trend more the average. In health examination, the occurrences having abdominal mass and tumefaction of superficial lymph node show a decreased trend. Among the patients having rough tumor surfaces, 77.5 percent of those are the seminoma. In examinations during different age, the use rate of B ultrasound each is 12.5%, 45.6% and 66.4%; that of pectoral X sheets each is 4.2%, 33.8% and 87.5%; Lymphangiography is 0, 4.4% and 1.6%; AFP is 0, 45.6% and 66.4%; HCG is 4.2%, 35.3% and 49.2%; CT in 80's and 90's is 4.4% and 40.6%;Color-ultrasound Doppler in 90's is 22.7%. In AFP, the positive rate in different subgroups respectively is: seminoma, 6.4%; embryonic cell cancer, 55.6%; yolk sac tumor, 90%; mixed germ cell tumor, 86.7%; teratoma and chorionic epithelioma both are 0. In HCG, the positive rate is: seminoma, 24.4%; embryonic cell cancer, 42.8%; yolk sac tumor and teratoma both are 0; mixed germ cell tumor, 57.1%, chorionic epithelioma, 100%. The constituent ratio of testicular tumor I phase in different age is a increased trend, and the number each is 62.5%, 63.2% and 73.4%; that of II phase shows a decreased trend, 0, 20.6% and 14.8%; that of III phase shows a more decreased trend, 37.5%, 16.2% and 11.7%. In quality of life, 18.1 percent of patients' sleeps are influenced by the disease. Sexual function is the second, 9.6%; There are57.4 percent of patients believing that health status has an effect on life; There are 48, 51.1% of those patients believing quality of life has an effect on life; There are 11.7 percent of patients knowing the knowledge about the treatment of testicular tumor; There are 72 patients hoping to know more knowledge about that. There are 37.2% of patients continue to be treated after discharge; There are 25 patients having periodic review.Conclusion With the development of the age, the average hospitalization per annum is gradually increased, and particularly in 90's, the trend is more notable. The average hospitalization rate per annum of testicular tumor in 90's is decreased remarkably. The ratio of patients having cryptorchidism is decreased gradually, and among of these patients seminoma is 60.35%; The medical history havingcryptorchidism or not has no effect on morbidity of seminoma; The ratio of seminoma is decreased a little; embryonic cell cancer is increased remarkably; gonadal hypothallus tumor all occur after 50 age (because the cases are not enough, the conclusion need to study more.), yolk sac tumor and teratoma occure easily in 20 age; The episode age of testicular tumor is gradually shifted to an earlier time; Health examination find out that there are 77.5% of seminoma having rough tumor surfaces, more than that of seminoma having smooth tumor surfaces; The extensive use of B ultrasound, color-ultrasound Doppler and CT have important significances to find and diagnosis effectively at early time, and AFP and HCG have big helpful to prognosis and the judgement of type; With the improvment of lymph node cleaning of retroperitoneum, the importance of the operation method is more and more high, but now the radical operation of testicular excision is the principal method, and clinical treatment trends to the comprehensive. The patients' demand of quality of life is not high, and the review and treatment after discharge are very poor, so it is very important to enhance publicizing the knowledge and significance of treatment of testicular tumor. |
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