Ficarra Vincenzo, Zattoni Filiberto, Cunico Sergio Cosciani, Galetti Tommaso Prayer, Luciani Lucio, Fandella Andrea, Guazzieri Stefano, Maruzzi Daniele, Sava Teodoro, Siracusano Salvatore, Pilloni Stefania, Tasca Andrea, Martignoni Guido, Gardiman Marina, Tardanico Regina, Zambolin Tiziano, Cisternino Antonio, Artibani Walter
Department of Urology, University of Verona, Verona, Italy.
Cancer. 2005 Jun 15;103(12):2507-16. doi: 10.1002/cncr.21076.
The objective of the current study was to identify independent clinical and pathologic variables that were predictive of lymph node involvement in patients with squamous cell carcinoma of the penis in a multicenter series with the intent to select patients who were suitable to undergo immediate inguinal lymphadenectomy.
Data were analyzed from 175 patients who underwent surgery for penile carcinoma in 11 urologic centers participating in the Gruppo Uro-Oncologico del Nord-Est (Northeast Uro-Oncological Group) Penile Cancer Data Base. Pathologically positive lymph nodes were defined as the presence of histologically confirmed lymph node metastasis in patients who underwent either immediate or delayed inguinal and/or pelvic lymphadenectomy. Patients who had clinically positive lymph nodes with cytologically positive fine-needle aspiration results and who had not undergone lymphadenectomy were censored.
Overall, lymph-node involvement was observed in 71 of 175 patients (40.6%) included in the analyses. After analyzing the whole group of patients, the following variables were identified as independent predictors of pathologic lymph node metastasis: clinical lymph node status, pathologic stage of the primary tumor, venous and lymphatic embolizations, and histologic grade. In the subgroup of patients with clinically negative lymph nodes, tumor thickness, histologic grade, lymphatic and venous embolizations, infiltration of both corpus spongiosum and urethra, and pathologic stage of the primary tumor (according to the 1997 TNM classification system) were predictive of lymph node involvement on univariate analysis. The generated logistic regression model showed that venous and/or lymphatic embolizations and infiltration of the corpus spongiosum and/or urethra were independent predictors of pathologic lymph node metastasis in patients with clinically negative lymph nodes.
Venous and/or lymphatic embolizations played relevant roles as predictors of pathologic lymph node involvement in patients with penile neoplasia and should be considered important parameters in determining which patients with clinically negative lymph nodes should undergo immediate lymphadenectomy.
本研究的目的是在一个多中心系列研究中，确定阴茎鳞状细胞癌患者发生淋巴结转移的独立临床和病理变量，以便选择适合立即行腹股沟淋巴结清扫术的患者。
分析了参与东北泌尿肿瘤学组阴茎癌数据库的11个泌尿外科中心175例行阴茎癌手术患者的数据。病理阳性淋巴结定义为在接受即刻或延迟腹股沟和/或盆腔淋巴结清扫术的患者中，经组织学证实存在淋巴结转移。对临床淋巴结阳性且细针穿刺细胞学结果阳性但未行淋巴结清扫术的患者进行了审查。
总体而言，纳入分析的175例患者中有71例（40.6%）出现淋巴结转移。在分析了整个患者组后，确定以下变量为病理淋巴结转移的独立预测因素：临床淋巴结状态、原发肿瘤的病理分期、静脉和淋巴管栓塞以及组织学分级。在临床淋巴结阴性的患者亚组中，单因素分析显示肿瘤厚度、组织学分级、淋巴管和静脉栓塞、海绵体和尿道浸润以及原发肿瘤的病理分期（根据1997年TNM分类系统）可预测淋巴结转移。生成的逻辑回归模型显示，静脉和/或淋巴管栓塞以及海绵体和/或尿道浸润是临床淋巴结阴性患者病理淋巴结转移的独立预测因素。
静脉和/或淋巴管栓塞在阴茎肿瘤患者病理淋巴结转移的预测中起重要作用，应被视为决定哪些临床淋巴结阴性患者应立即行淋巴结清扫术的重要参数。
