Guideline Statements
指南荟萃
Diagnosis and initial consultation
诊断和初步咨询
1. A solid mass in the testis identified by physical exam or imaging should be managed as a malignant neoplasm until proven otherwise. (Clinical Principle)
1. 通过查体或者影像学证实的睾丸实质性肿块应当按照恶性肿瘤对待，除非其它检查方法可以排除。（临床基本原则）
2. In a man with a solid mass in the testis suspicious for malignant neoplasm, serum tumor markers (AFP, hCG, and LDH) should be drawn and measured prior to any treatment, including orchiectomy. (Moderate Recommendation; Evidence Level: Grade C)
2. 当怀疑男性睾丸实质性新生物时，血清学标记物（AFPHCGLDH）检测应当在所有治疗之前进行，包括睾丸切除术。（中等推荐强度，证据水平C）
3. Prior to definitive management, patients should be counseled about the risks of hypogonadism and infertility (Moderate Recommendation; Evidence Level: Grade C) and should be offered sperm banking, when appropriate. In patients without a normal contralateral testis or with known subfertility, this should be considered prior to orchiectomy. (Clinical Principle)
3、在进行最终的治疗决定前，病人应到被告知可能出现性腺功能下降和不孕症，（中等推荐强度，证据水平C），在恰当的时机，可以提供精子存储方面信息。当病人出现睾丸发育不良或者生育功能低下时，应该在进行睾丸切除前进行告知。（临床基本原则）
4. Scrotal ultrasound with Doppler should be obtained in patients with a unilateral or bilateral scrotal mass suspicious for neoplasm. (Strong Recommendation; Evidence Level: Grade B)
4、当怀疑单侧或者双侧阴囊包块，应当进行多普勒超声检查。（强烈推荐，证据水平B）
5. Testicular microlithiasis in the absence of solid mass and risk factors for developing a GCT does not confer an increased risk of malignant neoplasm and does not require further evaluation. (Moderate Recommendation; Evidence Level: Grade C)
5、当无睾丸实质性肿块时，睾丸微石症不会增加恶变风险，不需要进一步评估。（中等推荐强度，证据水平C）
6. Patients with normal serum tumor markers (hCG and AFP) and indeterminate findings on physical exam or testicular ultrasound for testicular neoplasm should undergo repeat imaging in six to eight weeks. (Clinical Principle)
6、当病人的血清学标记物正常的时（hCG、AFP），查体和超声不能明确时，应当在6-8周后复查。（临床基本原则）
7. MRI should not be used in the initial evaluation and diagnosis of a testicular lesion suspicious for neoplasm. (Moderate Recommendation; Evidence Level: Grade C)
7、当怀疑睾丸肿瘤时，MRI检查不应该是首选的检查。（中等推荐强度，证据水平C）
Orchiectomy 睾丸切除术
8. Patients with a testicular lesion suspicious for malignant neoplasm and a normal contralateral testis should undergo a radical inguinal orchiectomy; testis-sparing surgery is not recommended. Transscrotal orchiectomy is discouraged. (Strong Recommendation; Evidence Level: Grade B)
8. 当病人怀疑睾丸恶性肿瘤时，同时对侧睾丸正常时，推荐进行经腹股沟切口的睾丸切除术，睾丸部分切除术是不推荐的。经阴囊切口是不合适的。（强烈推荐，证据水平B）
9. Testicular prosthesis should be discussed prior to orchiectomy. (Expert Opinion)
9. 可以在睾丸切除前和患者沟通睾丸假体的物理替代作用。（专家意见）
10. Patients who have undergone scrotal orchiectomy for malignant neoplasm should be counseled regarding the increased risk of local recurrence and may rarely be considered for adjunctive therapy (excision of scrotal scar or radiotherapy) for local control. (Moderate Recommendation; Evidence Level: Grade C)
10. 对于怀疑恶性肿瘤而接受经阴囊切口睾丸切除术的患者，应就局部复发的风险增加进行咨询，并且可能很少推荐进行局部控制的辅助治疗（阴囊瘢痕切除或放射治疗）。（中度推荐；证据等级：C级）
Testis-sparing surgery睾丸部分切除术
11a. TSS through an inguinal incision may be offered as an alternative to radical inguinal orchiectomy in highly selected patients wishing to preserve gonadal function with masses <2cm and (1) equivocal ultrasound/physical exam findings and negative tumor markers (hCG and AFP), (2) congenital, acquired or functionally solitary testis, or (3) bilateral synchronous tumors. (Conditional Recommendation; Evidence Level: Grade C)
11a. 当肿块小于2cm，且病人有强烈的性腺器官保留愿望时，可以选择经腹股沟切口的睾丸部分切除。以下情况时可以考虑：1、当超声和查体不能明确，肿瘤标志物（hCG、AFP）阴性时；2、先天性、后天性或者功能性只有一个睾丸时；3、双侧肿瘤。（条件性推荐，证据水平C）
11b. Patients considering TSS should be counseled regarding (1) higher risk of local recurrence, (2) need for monitoring with physical examination and ultrasound, (3) role of adjuvant radiotherapy to the testicle to reduce local recurrence, (4) impact of radiotherapy on sperm and testosterone production, and (5) the risk of testicular atrophy and need for testosterone replacement therapy, and/or subfertility/infertility. (Moderate Recommendation; Evidence Level: Grade C)
11b. 病人要求睾丸部分切除时应当告知：1、高复发风险；2、需要定期超声和查体监测；3、放疗减少肿瘤的复发；4、放疗对睾酮的影响；5、睾丸萎缩和睾酮替代治疗，不育和生育力下降。（中等推荐强度，证据水平C）
11c. When TSS is performed, in addition to the suspicious mass, multiple biopsies of the ipsilateral testicle normal parenchyma should be obtained for evaluation by an experienced genitourinary pathologist. (Moderate Recommendation; Evidence Level: Grade C)
11c. 当进行睾丸部分切除术后，应当由有经验的泌尿生殖病理学家对怀疑可能恶性的同侧睾丸部位进行多点活检。（中等推荐强度，证据水平C）
GCNIS counseling and management
原位生殖细胞肿瘤病例需知及随访管理
12. Clinicians should inform patients with a history of GCT or GCNIS of risks of a second primary tumor while rare is significantly increased in the contralateral testis. (Moderate Recommendation; Evidence Level: Grade B)
12. 临床医师应当告知具有生殖细胞肿瘤和原位生殖细胞肿瘤病史的病人患对侧睾丸肿瘤增加的意义。（中等推荐强度，证据水平B)
13a. In patients with GCNIS on testis biopsy or malignant neoplasm after TSS, clinicians should inform patients of the risks/benefits of surveillance, radiation, and orchiectomy. (Moderate Recommendation; Evidence Level: Grade C)
13a. 当睾丸部分切除术后病理证实为原位生殖细胞肿瘤时，临床医师应当告知病人密切观察、放疗以及根治的利弊。（中等推荐强度，证据水平C）
13b. Clinicians should recommend surveillance in patients with GCNIS or malignant neoplasm after TSS who prioritize preservation of fertility and testicular androgen production. (Moderate Recommendation; Evidence Level: Grade C)
13b. 临床医师应当建议原位生殖细胞肿瘤密切观察的患者或睾丸部分切除术后的病人优先进行生育能力和雄性激素的保存。（中等推荐强度，证据水平C）
13c. Clinicians should recommend testicular radiation (18-20 Gy) or orchiectomy in patients with GCNIS or malignant neoplasm after TSS who prioritize reduction of cancer risk taking into consideration that radiation reduces the risk of hypogonadism compared to orchiectomy. (Moderate Recommendation; Evidence Level: Grade C)
13c. 临床医师应当建议原位生殖细胞肿瘤或者怀疑睾丸恶性肿瘤行睾丸部分切除术后病人进行18-20Gy放疗和睾丸切除术在减少肿瘤复时放疗对性激素下降的影响优于睾丸切除术。（中等推荐强度，证据水平C）
Serum tumor markers
血清肿瘤标志物
14. Nadir serum tumor markers (AFP, hCG, and LDH) should be repeated at appropriate T1/2 time intervals after orchiectomy for staging and risk stratification. (Moderate Recommendation; Evidence Level: Grade B)
14. 睾丸切除术后进行分级和危险分层时基线的肿瘤标志物（AFPHCGLDH）应当进行重复检测。（中等推荐强度，证据水平B)
15. For patients with elevated AFP or hCG post-orchiectomy, clinicians should monitor serum tumor markers to establish nadir levels before treatment only if marker nadir levels would influence treatment. (Clinical Principle)
15. 当病人行睾丸切除术后出现肿瘤标记物逐步上升，只有如果基线水平影响临床治疗时，临床医师则应当在进行治疗之前密切监测基线水平。（临床基本原则）
16. For patients with metastatic GCT (Stage IIC or III) requiring chemotherapy, clinicians must base chemotherapy regimen and number of cycles on the IGCCCG risk stratification. IGCCCG risk stratification is based on nadir serum tumor marker (hCG, AFP and LDH) levels obtained prior to the initiation of chemotherapy, staging imaging studies, and tumor histology following radical orchiectomy (Strong Recommendation; Evidence Level: Grade A). Any post-pubertal male, regardless of age, should be treated according to adult treatment guidelines. (Moderate Recommendation; Evidence Level: Grade B)
16. 对于需要化疗的转移性GCT（IIC或III期）患者，临床医师必须根据IGCCCG风险分层确定化疗方案和周期数。IGCCG危险分层是根据化疗开始前的基线血清学肿瘤标志物（hCG、AFP和LDH）水平、影像学和根治性睾丸切除术后的肿瘤病理来确定的。（强烈推荐；证据水平：A级）。任何青春期后的男性病人，无论年龄大小，都应参考成人的治疗指南进行治疗。（中度推荐；证据等级：B级）
17. For patients in whom serum tumor marker (AFP and hCG) levels are borderline elevated (within 3x upper limit of normal) post-orchiectomy, a rising trend should be confirmed before management decisions are made as falsepositive elevations may occur. (Clinical Principle)
17. 对于血清肿瘤标志物（AFP和HCG）水平升高的患者（睾丸切除术后超过正常范围的3倍上限），在做出临床决策之前应上升趋势进行确认，因为可能出现瘤标升高的假阳性。（临床基本原则）
Imaging 影像学
18. In patients with newly diagnosed GCT, clinicians must obtain a CT scan of the abdomen and pelvis with IV contrast or MRI if CT is contraindicated. (Strong Recommendation; Evidence Level: Grade B)
18. 对于新诊断的生殖细胞肿瘤病人，必须完善盆腔和骨盆的增强ct扫描，如果对行ct检查有禁忌症的病人，可考虑行静脉肾盂造影或MRI检查替代。（强烈推荐；证据水平：B级）
19a. In patients with newly diagnosed GCT, clinicians must obtain chest imaging. (Clinical Principle)
19a. 对于新诊断的生殖细胞肿瘤病人，临床上必须完善胸部检查。（临床基本原则）
19b. In the presence of elevated and rising post-orchiectomy markers (hCG and AFP) or evidence of metastases on abdominal/pelvic imaging, chest x-ray or physical exam, a CT chest should be obtained. (Strong Recommendation; Evidence Level: Grade C)
19b. 如果睾丸切除术后出现肿瘤标志物（HCG和AFP）升高或有腹部/盆腔影像学、胸部X光或体格检查有转移等证据等病人，应当完善胸部CT检查。（强烈推荐；证据等级：C级）
19c. In patients with clinical stage I seminoma, clinicians should preferentially obtain a chest x-ray over a CT scan. (Moderate Recommendation; Evidence Level: Grade B)
19c. 对于临床I期精原细胞瘤病人，临床医生应首先进行胸部X光检查而不是CT扫描。（中度推荐；证据等级：B级）
19d. In patients with NSGCT, clinicians may preferentially obtain a CT scan of the chest over a chest x-ray and should prioritize CT chest for those patients recommended to receive adjuvant therapy. (Conditional Recommendation; Evidence Level: Grade C)
19d. 对于NSGCT患者，临床医生应优先进行胸部的CT扫描，而不是胸部X光片，对于建议接受辅助治疗的患者，应优先考虑CT胸部。（有条件推荐.证据等级：C级）
20. In patients with newly diagnosed GCT, clinicians should not obtain a PET scan for staging. (Strong Recommendation; Evidence Level: Grade B)
20. 对于新诊断为GCT的患者，临床医生不应使用PET扫描来进行分期。（强烈推荐；证据等级：B级）
21. Patients should be assigned a TNM-s category to guide management decisions. (Strong Recommendation; Evidence Level: Grade B)
21. 病人应当根据TNM分期来指导治疗决策。（强烈推荐；证据等级：B级）
Principles of management 治疗原则
22. Management decisions should be based on imaging obtained within the preceding 4 weeks and serum tumor markers (hCG and AFP) within the preceding 10 days. (Expert Opinion)
22、治疗决策应基于在4周内获得的影像学检查结果和10天内的血清肿瘤标志物（hCG和AFP）来进行。（专家意见）
23. Management decisions should be made in a multidisciplinary setting involving experienced clinicians in urology, medical oncology, radiation oncology, pathology, and radiology. (Clinical Principle)
23、治疗决策的作出应包括多学科团队，包括由泌尿科、医学肿瘤学、放射肿瘤学、病理学和放射科的经验丰富的临床医师组成。（临床基本原则）
24. Expert review of pathologic specimens should be considered in clinical scenarios where treatment decisions will be impacted. (Moderate Recommendation; Evidence Level: Grade C)
24、在对临床治疗可能有影响的时候，应考虑对病理标本进行专家复查。（中度推荐；证据等级：C级）
25. In patients with normal serum tumor markers (hCG and AFP) and equivocal imaging findings for metastasis, clinicians may consider repeat imaging in six to eight weeks to clarify the extent of disease prior to making a treatment recommendation. (Clinical Principle)
25、在血清肿瘤标志物正常（HCG和AFP）和有明确的影像学转移的病人中，临床医生可以考虑在六至八周内重复检查，以在制定治疗决定建议之前明确疾病的程度。（临床基本原则）
Seminoma management
精原细胞瘤治疗-surveillance/RPLND/chemotherapy/radiation
-监测/腹膜后淋巴结清扫术/化疗/放疗
26. Clinicians should recommend surveillance after orchiectomy for patients with stage I seminoma. Adjuvant radiotherapy and carboplatin-based chemotherapy are less preferred alternatives. (Strong Recommendation; Evidence Level: Grade B)
26、临床医生应建议I期精原细胞瘤患者行睾丸切除术后的进行严密监测。辅助放疗和卡铂化疗治疗效果有待商榷。（强烈推荐；证据等级：B级）
27. For patients with stage IIA or IIB seminoma with a lymph node ≤3cm, clinicians should recommend radiation therapy or multi-agent cisplatin-based chemotherapy based on shared decision-making. (Moderate Recommendation; Evidence Level: Grade B). For patients with IIB seminoma with a lymph node >3 cm, chemotherapy is recommended. (Moderate Recommendation; Evidence Level: Grade B)
27、对于淋巴结小于等于3cm的Ⅱa期或Ⅱb期精原细胞瘤患者，临床医生应根据会诊讨论决策推荐放射治疗或包括顺铂的多药化疗。（中等推荐；证据等级：B级）。对于淋巴结大于3cm的IIB精原细胞瘤患者，建议进行化疗。（中度推荐；证据等级：B级）
Non seminoma management
非精原细胞瘤治疗
28. Clinicians should recommend risk-appropriate, multi-agent chemotherapy for patients with NSGCT with elevated and rising post-orchiectomy serum AFP or hCG (i.e. stage TanyN1-2S1). (Strong Recommendation; Evidence Level: Grade B)
28、临床医生应推荐对睾丸切除术后血清AFP或hCG升高的具有高危因素的NSGCT患者进行多药化疗（N1-2S1）。（强烈推荐；证据等级：B级）
29. Clinicians should recommend surveillance for patients with stage IA NSGCT. RPLND or one cycle of bleomycin, etoposide, and cisplatin chemotherapy are effective and appropriate alternative treatment options for patients who decline surveillance or are at risk for non-compliance. (Moderate Recommendation; Evidence Level: Grade B)
29、临床医生应建议对IA期NSGCT患者进行监测。腹膜后淋巴结清扫或一个周期的博莱霉素、依托泊苷和顺铂化疗对于那些拒绝监测或医从性较差的患者是有效和适当的替代治疗选择。（中度推荐；证据等级：B级）
30. For patients with stage IB NSGCT, clinicians should recommend surveillance, RPLND, or one or two cycles of bleomycin, etoposide, and cisplatin chemotherapy based on shared decision-making. (Strong Recommendation; Evidence Level: Grade B)
30、对于Ib期NSGCT患者，临床医生应根据会诊讨论结果建议监测、腹膜后淋巴结清扫或一到两个周期的博莱霉素、依托泊苷和顺铂化疗。（强烈推荐；证据等级：B级）
31. Patients with stage I NSGCT and any secondary somatic malignancy (also known as teratoma with malignant transformation) in the primary tumor at orchiectomy should undergo RPLND. (Expert Opinion)
31、I期NSGCT病人和睾丸切除术后继发的体表恶性肿瘤（也称为恶性畸胎瘤）的病人应接受腹膜后淋巴结清扫。（专家意见）
32. Clinicians should recommend RPLND or chemotherapy for patients with stage IIA NSGCT with normal postorchiectomy serum (S0) AFP and hCG. (Moderate Recommendation; Evidence Level: Grade B)
32、临床医生应推荐术后血清正常（S0期）（AFP和HCG的）的IIA NSGCT期病人进行腹膜后淋巴结清扫或化疗。（中度推荐；证据等级：B级）
33. In patients with clinical stage IIB NSGCT and normal post-orchiectomy serum AFP and hCG, clinicians should recommend risk-appropriate, multi-agent chemotherapy. (Moderate Recommendation; Evidence Level: Grade B). Clinicians may offer RPLND as an alternative to chemotherapy to select patients with clinical stage IIB NSGCT with normal post-orchiectomy serum AFP and hCG. (Conditional Recommendation; Evidence Level: Grade C)
33、对临床分期为IIB的NSGCT和睾丸切除术后血清AFP和HCG正常的病人，临床医生应推荐有一定风险的多药化疗。（中等推荐；证据等级：B级）。临床医生可以选择临床分期IIB NSGCT、术后血清AFP和HCG正常的病人，提供RPLND作为化疗替代方案。（有条件推荐.证据等级：C级）
34. Among patients who are candidates for RPLND, it is recommended clinicians consider referral to an experienced surgeon at a high-volume center. (Moderate Recommendation; Evidence Level: Grade C)
34、在对于需要行RPLND的病人，建议转诊到有过多例类似手术史的大的临床经验丰富的医疗中心进行。（中度推荐；证据等级：C级）
35. Surgeons with experience in the management of GCT and expertise in minimally invasive surgery may offer a minimally-invasive RPLND, acknowledging the lack of long-term data on oncologic outcomes. (Expert Opinion)
35. 具有生殖细胞肿瘤管理经验和微创手术专业知识的外科医生可以提供微创的腹膜后淋巴结清扫术，对于该术式目前缺乏关于肿瘤结果的长期数据。（专家意见）
36. Primary RPLND should be performed with curative intent in all patients. RPLND should be performed with adherence to the following anatomical principles, regardless of the intent to administer adjuvant chemotherapy. These principles are applied to both open and minimally-invasive approaches. (Moderate Recommendation; Evidence Level: Grade B).
· A full bilateral template dissection should be performed in patients with suspicious lymph nodes based on CT imaging or intraoperative assessment and in those with somatictype malignancy in the primary tumor.
· A full bilateral template or modified template dissection may be performed in patients with clinically negative lymph nodes.
· A right modified template dissection may omit the para-aortic lymph nodes below the inferior mesenteric artery. Omission of para-aortic lymph nodes above the inferior mesenteric artery is controversial.
· A left modified template dissection may omit paracaval, precaval, and retrocaval lymph nodes. Omission of interaortocaval lymph nodes is controversial.
· Nerve-sparing should be offered in select patients desiring preservation of ejaculatory function.
· Nerve-sparing attempts should not compromise the quality of the lymph node dissection.
· A complete retroaortic and/or retrocaval lymph node dissection with division of lumbar vessels should be performed when within the planned template.
· The ipsilateral gonadal vessels should be removed in all patients.
· The cephalad extent of the dissection is the crus of the diaphragm to the level of the renal arteries. The caudad extent of disease is the crossing of the ureter over the ipsilateral common iliac artery.
36. 所有具有治疗意愿的患者均进行基本的腹膜后淋巴结清扫。无论是否打算进行辅助化疗，腹膜后淋巴结清扫都应遵循以下解剖原则。这些原则适用于开放和微创的术式。（中等推荐；证据等级：B级）。
· 经CT检查可疑或术中发现可疑淋巴结的体表原发的恶性肿瘤的病人应进行双侧淋巴结清扫。
· 对于临床阴性的淋巴结患者，可以进行完全的双侧标准或改良的淋巴结清扫。
· 对于右侧改良的淋巴结清扫术可能遗漏主动脉旁肠系膜下动脉淋巴结。遗漏对腹主动脉旁以上的淋巴结目前具有争议。
· 左侧改良的清扫术可能遗漏腔静脉旁、腔静脉前和腔静脉后淋巴结。遗漏腔静脉间淋巴结是有争议的。
· 对于希望保留射精功能的患者，应进行神经保护。
· 不应降低淋巴结清扫的质量来保护性神经。
· 标准的淋巴结清扫应当包括完整的主动脉后和/或腔后淋巴结解剖和部分腰静脉的游离。
· 所有患者应切除同侧性腺血管。
· 头侧的解剖范围是横膈膜到肾动脉的水平。病变的尾端是输尿管与同侧髂总动脉的交叉。
37. After primary RPLND, clinicians should recommend surveillance or adjuvant chemotherapy in patients with NSGCT who have pathological stage II disease that is not pure teratoma. For patients with pN1 and/or pN1-3 pure teratoma, surveillance is preferred. For patients with pN2-3 at RPLND, multi-agent cisplatin-based chemotherapy is preferred. (Moderate Recommendation; Evidence Level: Grade B)
37. 标准的腹膜后淋巴结清扫后，临床医生应建议对非单纯畸胎瘤的病理分期为II期的NSGCT患者进行监测或辅助化疗。对于pN1和/或pN1-3单纯畸胎瘤患者，最好进行监测。对于行腹膜后淋巴结清扫的分期为pN2-3的患者，以顺铂为基础的多药化疗是首选。（中度推荐；证据等级：B级）
38. For patients with clinical stage I seminoma choosing surveillance, clinicians should obtain a history and physical examination and perform cross-sectional imaging of the abdomen with or without the pelvis, every 4-6 months for the first 2 years, and then every 6-12 months in years 3-5. Routine surveillance imaging of the chest and serum tumor marker assessment can be obtained as clinically indicated. (Moderate Recommendation; Evidence Level: Grade B)
38. 对于临床I期精原细胞瘤患者选择监测，临床医生应获得病史和进行体格检查，并对腹部（包括或不包括骨盆）进行横断面成像，间隔时间为头2年每4-6个月，第3-5年每6-12个月。胸部和血清肿瘤标志物评估的常规监测对临床有指导意义。（中度推荐；证据等级：B级）
39. In patients with stage I NSGCT undergoing surveillance after orchiectomy, clinicians should perform a physical examination and obtain serum tumor markers (AFP, hCG +/- LDH) every 2-3 months in year 1, every 2-4 months in year 2, every 4-6 months in year 3, and every 6-12 months for years 4 and 5. (Moderate Recommendation; Evidence Level: Grade C)
39. 对于分期为Ⅰ期的接受睾丸切除术后监测的NSGCT患者，临床医生应在第一年每2-3个月进行一次检查，并获得血清肿瘤标志物（AFP、hCG+/-LDH）。第二年每2-4个月进行，第三年每4-6个月、第四年和第五年每6-12个月进行。（中度推荐；证据等级：C级）
40. In patients with stage I NSGCT undergoing surveillance after orchiectomy, radiologic assessment (chest x-ray and imaging of the abdomen with or without the pelvis) should be obtained every 3-6 months in year 1 starting at 3 months, every 4-12 months in year 2, once in year 3, and once in year 4 or 5. (Moderate Recommendation; Evidence Level: Grade B) Men at higher risk of relapse (e.g., lymphovascular invasion) should be imaged with shorter intervals. (Expert Opinion)
40. 在接受睾丸切除术后监测的I期NSGCT患者中，从3个月开始，第1年每3-6个月，第2年每4-12个月，第3年1次，第4或第5年1次，应进行一次放射学评估（胸部X光和腹部有或无骨盆成像）。（中度建议；证据水平：B级）复发风险较高（如淋巴血管侵犯）的男性应缩短检查间隔。（专家意见）
41. Patients who relapse on surveillance should be fully restaged and treated based on their TNM-s status. (Moderate Recommendation; Evidence Level: Grade C)
41. 监测过程中复发的患者应根据其TNM进行充分的康复和治疗。（中度推荐；证据等级：C级）
42. Clinicians should inform patients with stage I GCT on surveillance of the ≤1% risk of late relapse after 5 years. (Moderate Recommendation; Evidence Level: Grade B) Annual serologic and radiographic assessment may be performed thereafter as indicated based upon clinical concerns. (Clinical Principle)
42. 临床医生应告知I期GCT患者，监测5年后的复发风险≤1%。（中度推荐；证据等级：B级）根据临床需要，可在此后进行每年一次的血清学和放射学评估。（临床基本原则）
43. Patients with GCT should be monitored for signs and symptoms of hypogonadism. If present, serum AM testosterone and luteinizing hormone levels should be measured. (Clinical Principle)
43. 应监测GCT患者是否有性腺功能减退的症状和体征。如果存在，应测量血清睾酮和促黄体激素水平。（临床基本原则）
44. Patients with a history of GCT whose treatment has included radiation therapy, chemotherapy, or both should be advised of the elevated risk of cardiovascular disease (Conditional Recommendation; Evidence Level: Grade C) and should establish regular care with a primary care physician so that modifiable risk factors for cardiovascular disease (e.g., diet, exercise, smoking, serum lipid levels, blood pressure, serum glucose)can be monitored. (Expert Opinion)
44. 有GCT病史的患者，其治疗包括放射治疗、化疗或两者兼而有之，应告知其有增加心血管疾病风险的可能（有条件的建议；证据等级：C级），并应与初级保健医师建立定期沟通，以改变可能导致心血管疾病的危险因素（例如：可以监测饮食、运动、吸烟、血脂水平、血压、血糖。（专家意见）
45. Patients with a history of GCT whose treatment has included radiation therapy, chemotherapy, or both should be advised of the elevated risk of secondary malignancy (Conditional Recommendation; Evidence Level: Grade C) and should establish regular care with a primary care physician for appropriate health care maintenance and cancer screening as appropriate. (Expert Opinion)
45. 有GCT病史的患者，其治疗包括放射治疗、化疗或二者兼而有之，应告知其继发性恶性肿瘤的风险升高（有条件建议；证据等级：C级），并应与初级保健医师建立定期护理，以进行合适的医疗和癌症筛查。（专家意见）
PDF指南全文获取方式：【AUA指南更新】膀胱过度活动症（OAB）
