化疗（CHT）或放疗（RT）是临床II期睾丸精原细胞瘤（CS-II）的一线治疗方法。历史上，临床I期（CS-I）的精原细胞瘤也使用化疗或放疗进行治疗，但在过去的二十年中，临床实践已经转向对CS-I进行积极观察，而将放疗或化疗保留给进展为CS-II的患者。目前关于现代放疗技术和患者分层的数据有限，例如原发性（睾丸切除术时为CS-II）与复发性（在CS-I观察期间诊断为CS-II）之间的比较。我们调查了在两个医疗机构接受放疗治疗的CS-II患者的预后。回顾性研究确定了2001年至2022年间接受放疗治疗的73例CS-II A或B期精原细胞瘤患者。通过Kaplan-Meier方法计算复发无病生存率（RFS），并用Log-Rank或Cox比例风险回归进行单因素分析。复发定义为RT完成后病理证实的转移性精原细胞瘤。第二原发肿瘤定义为先前放疗区域内病理证实的恶性肿瘤。38例（52%）患者呈现为原发性CS-II，而35例（48%）患者为复发性CS-II。中位随访时间为4.8年（IQR：2.3 - 8.1）。总体5年复发无病生存率为82%（复发性患者为92%，原发性患者为73%）。与原发性CS-II相比，复发性CS-II的复发率在放疗后较低。所有复发均发生在先前放疗区域外，并得到了挽救。疾病特异生存率为100%。发生了两例第二原发肿瘤（前列腺癌，结直肠癌，分别为接受RT后的67个月和119个月）。在接受现代放疗治疗的CS-II精原细胞瘤患者中，没有区域内复发。原发性CS-II的呈现与区域外复发相关。在经过进一步大规模验证的基础上，我们的结果表明，与复发时的CS-II相比，原发性CS-II可能预示着更具侵袭性或微转移的腹膜后疾病，从而可能获益于放疗后的化疗。版权所有 © 2023 Elsevier Inc.发表。

Chemotherapy (CHT) or radiation therapy (RT) are first line treatments for clinical stage II testicular seminoma (CS-II). Historically, clinical stage I (CS-I) seminoma was also treated with CHT or RT, but in the past two decades practice has shifted towards active surveillance for CS-Iwith RT or CHT reserved for patients with progression to CS-II. Limited data exist on contemporary RT techniques and patient stratification, i.e. de novo (CS-II at orchiectomy) vs. relapsed (CS-II diagnosed during surveillance after orchiectomy for CS I). We investigated outcomes in CS-II patients treated with RT in the modern era across two institutions.A retrospective review identified 73 patients treated with RT for CS-II A or B seminoma between 2001-2022. Recurrence free survival (RFS) was calculated by the Kaplan-Meier method and univariate analyses were performed with Log-Rank or Cox proportional hazard regression. Recurrence was defined as biopsy-proven metastatic seminoma after RT completion. Second malignancies were defined as a biopsy-proven malignancy originating in the prior RT field.Thirty-eight (52%) patients presented with de novo CS-II while 35 (48%) patients had relapsed CS-II. Median follow-up was 4.8 years (IQR: 2.3 - 8.1). Five-year RFS was 82% overall (92% in relapsed patients and 73% in de novo patients). Relapsed CS-II disease had lower recurrence rates following RT compared to de novo CS-II disease. All recurrences occurred outside the prior RT field and were salvaged. Disease-specific survival was 100%. Two second malignancies occurred (prostate, colorectal cancer at 67 months and 119 months post-RT, respectively).In patients with CS-II seminoma treated with modern RT, there were no in-field recurrences. Presentation with de novo CS-II is associated with out-of-field recurrence. Subject to further larger-scale validation, our results suggest that compared to CS-II at time of relapse, de novo CS-II may portend more aggressive or micrometastatic disease beyond the retroperitoneum, raising the possibility of benefit from chemotherapy after radiation.Copyright © 2023. Published by Elsevier Inc.