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Góðar lífshorfur karla með sáðkrabbamein : afturskyggn rannsókn á íslenskum körlum greindum 1971-1990

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Authors
Tómas Guðbjartsson
Reynir Björnsson
Kjartan Magnússon
Sigurður Björnsson
Guðmundur Vikar Einarsson
Issue Date
1996-03-01

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Other Titles
Good survival of Icelandic men diagnosed with testicular seminoma between 1971 and 1990 - A retrospective study
Citation
Læknablaðið 1996, 82(3):202-8, 210
Abstract
Testicular cancer is the most common cancer diagnosed in males aged 20 to 34 in Iceland. A retrospective population-based study was carried out on all Icelandic males diagnosed between 1971 and 1990 to evaluate presentation and survival of seminoma in Iceland. Fortyseven males with average age of 36 years (range 21-71) were included. Clinical informations were gained from the Icelandic Cancer Registry and hospital records. The staging system used was a modification of the system orginally proposed by Boden and Gibb and crude probability of survival was evaluated with the Kaplan-Meier method. Age standardized incidence for seminoma was 2.0/ 100,000 males per year for the whole period. Forty-five patients were diagnosed with symptoms where testicular swelling (98%) and pain (42%) were the most common symptoms. Two patients were diagnosed incidentally. All the patients except one underwent orchiectomy, 66% also received radiotherapy and 9% chemotherapy. Average tumor diameter was 8 cm before 1981 but 5.2 cm after 1981 (p=0.02). Most patients were diagnosed in stage I (73%), but 27% had disseminated disease at diagnosis (stage II-IV), most commonly retroperitoneal lymphnode metastases (85%). Crude five and 10 year survival was 89% and 84% respectively. Nine patients have died (August 1994) but none of seminoma. The incidence of seminoma is moderate in Iceland compared to the Nordic countries. Clinical symptoms and stage at diagnosis are similar. Survival is excellent for the group as a whole. For small localized tumors orchiectomy and surveillance seem to be an appropriate approach.
Krabbamein í eistum eru algengustu illkynja æxlin sem greinast í ungum karlmönnum á Íslandi. Með öflugri geislameðferð og nýjum krabbameinslyfjum hafa lífsgæði og lífshorfur þessara sjúklinga batnað og í dag eru þau í hópi krabbameina sem mestar líkur eru á að lækna. Markmið rannsóknarinnar var að kanna með hvaða hætti sáðkrabbamein (seminoma) greinist á Íslandi, nýgengi, stigun og lífshorfur sjúklinganna við greiningu. Rannsóknin er afturskyggn og nær til allra íslenskra karla sem greindust með sáðkrabbamein á Íslandi frá 1971 til 1990. Alls greindust 47 einstaklingar og var meðalaldur 36 ár, aldursbil 21-71 ár. Úr sjúkraskrám fengust upplýsingar um aldur sjúklinganna, greiningarár, einkenni, rannsóknir og meðferð. Öll æxlin voru stiguð samkvæmt afbrigði af Boden og Gibb stigunarkerfi og lífshorfur reiknaðar með Kaplan-Meier aðferð. Loks var kannað hverjir hefðu látist vegna sáðkrabbameins. Aldursstaðlað nýgengi sáðkrabbameins á rannsóknatímabilinu var 2,0 fyrir 100.000 karla á ári. Af 47 sjúklingum greindust tveir fyrir tilviljun en aðrir með einkenni þar sem fyrirferð (98%) og verkir í eista (42%) voru algengust, en 11% höfðu einkenni meinvarpa. Flestir höfðu einkenni í einn til fjóra mánuði fyrir greiningu (34%) en 25% greindust eftir meira en sex mánuði. Meðalstærð æxlanna var 6,1 cm og fór minnkandi eftir 1981, eða úr 8 cm í 5,2 cm. Flest æxlin voru meðhöndluð með brottnámi eistans (98%), 66% sjúklinga fengu einnig geisla og 9% krabbameinslyfjameðferð. Æxlin voru stiguð og voru 73% æxlanna á stigi I, 20% voru á stigi II, 2% á stigi III og 5% æxlanna voru á stigi IV. Fimm ára lífshorfur fyrir hópinn í heild voru 89% og 10 ára lífshorfur 84%. Níu sjúklinganna voru látnir í ágúst 1994, enginn vegna sáðkrabbameins. Nýgengi sáðkrabbameins er í meðallagi á Íslandi og klínísk hegðun og sjúkdómsstigun sambærileg og í nágrannalöndum okkar. Lífshorfur karla meö sáðkrabbamein eru mjög góðar á Íslandi jafnvel í tilfellum þar sem sjúkdómurinn er útbreiddur. Ef æxlið er lítið og sjúkdómurinn staðbundinn er brottnám eistans nægileg meðferð.
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