Zouhair A, Coucke P A, Jeanneret W, Douglas P, Do H P, Jichlinski P, Mirimanoff R O, Ozsahin M
Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
Eur J Cancer. 2001 Jan;37(2):198-203. doi: 10.1016/s0959-8049(00)00368-3.
To assess the prognostic factors and the outcome in patients with squamous-cell carcinoma of the penis, a retrospective review of 41 consecutive patients with non-metastatic invasive carcinoma of the penis, treated between 1962 and 1994, was performed. The median age was 59 years (range: 35-76 years). According to the International Union Against Cancer (UICC) 1997 classification, there were 12 (29%) T1, 24 (59%) T2, 4 (10%) T3 and 1 TX (2%) tumours. The N-classification was distributed as follows: 29 (71%) patients with N0, 8 (20%) with N1, 3 (7%) with N2 and 1 (2%) with N3. Forty-four per cent (n=18) of the patients underwent surgery: partial penectomy with (n=4) or without (n=12) lymph node dissection, or total penectomy with (n=1) or without (n=1) lymph node dissection. 23 patients were treated with radiation therapy alone, and all but 4 of the patients who were operated upon received postoperative radiation therapy (n=14). The median follow-up period was 70 months (range 20-331 months). In a median period of 12 months (range 5-139 months), 63% (n=26) of the patients relapsed (local in 18, locoregional in 2, regional in 3 and distant in 3). Local failure (stump in the operated patients, and the tumour bed in those treated with primary radiation therapy) was observed in 4 out of 16 (25%) patients treated with partial penectomy +/-postoperative radiotherapy versus 14 out of 23 (61%) treated with primary radiotherapy (P=0.06). 15 (83%) out of 18 local failures were successfully salvaged with surgery. In all patients, 5- and 10-year survival rates were 57% (95% confidence interval (CI), 41-73%) and 38% (95% CI, 21-55%), respectively. The 5-year local and locoregional rates were 57% (95% CI, 41-73%) and 48% (95% CI, 32-64%), respectively. In patients treated with primary radiotherapy, 5- and 10-year probabilities of surviving with penis preservation were 36% (95% CI, 22-50%) and 18% (95% CI, 2-34%), respectively. In multivariate analyses, survival was significantly influenced by the N-classification, and surgery was the only independent factor predicting the locoregional control. We conclude that, in patients with squamous-cell carcinoma of the penis, local control is better in patients treated with surgery. However, there seems to be no difference in terms of survival between patients treated by surgery and those treated by primary radiotherapy +/-salvage surgery, with 39% having organ preservation.
为评估阴茎鳞状细胞癌患者的预后因素及结局，我们对1962年至1994年间连续收治的41例非转移性阴茎浸润癌患者进行了回顾性研究。患者年龄中位数为59岁（范围：35 - 76岁）。根据国际抗癌联盟（UICC）1997年分类标准，T1期肿瘤12例（29%），T2期肿瘤24例（59%），T3期肿瘤4例（10%），TX期肿瘤1例（2%）。N分期分布如下：N0期患者29例（71%），N1期患者8例（20%），N2期患者3例（7%），N3期患者1例（2%）。44%（n = 18）的患者接受了手术治疗：部分阴茎切除术（4例伴或12例不伴淋巴结清扫），或全阴茎切除术（1例伴或1例不伴淋巴结清扫）。23例患者仅接受放射治疗，除4例手术患者外，其余所有手术患者均接受了术后放射治疗（n = 14）。中位随访期为70个月（范围20 - 331个月）。在中位12个月（范围5 - 139个月）的时间里，63%（n = 26）的患者复发（18例为局部复发，2例为局部区域复发，3例为区域复发，3例为远处复发）。接受部分阴茎切除术±术后放疗的16例患者中有4例（25%）出现局部失败（手术患者为残端，接受原发放疗患者为肿瘤床），而接受原发放疗的23例患者中有14例（61%）出现局部失败（P = 0.06）。18例局部复发患者中有15例（83%）通过手术成功挽救。所有患者的5年和10年生存率分别为57%（95%置信区间（CI），41 - 73%）和38%（95% CI，21 - 55%）。5年局部和局部区域控制率分别为57%（95% CI，41 - 73%）和48%（95% CI，32 - 64%）。在接受原发放疗的患者中，保留阴茎存活的5年和10年概率分别为36%（95% CI，22 - 50%）和18%（95% CI，2 - 34%）。多因素分析显示，生存受N分期显著影响，手术是预测局部区域控制的唯一独立因素。我们得出结论，在阴茎鳞状细胞癌患者中，手术治疗患者的局部控制效果更好。然而，手术治疗患者与接受原发放疗±挽救性手术治疗患者的生存率似乎没有差异，39%的患者实现了器官保留。
