Kroon Bin K, Nieweg Omgo E, van Boven Hester, Horenblas Simon
Department of Urology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
J Urol. 2006 Jul;176(1):105-8. doi: 10.1016/S0022-5347(06)00500-3.
The majority of patients with penile cancer with a tumor positive sentinel node do not benefit from complementary lymph node dissection because of absent additional involved nodes. We analyzed factors that may determine the involvement of additional nodes.
A total of 158 patients with clinically node negative penile carcinoma underwent sentinel node biopsy. Complementary inguinal lymph node dissection was performed when the sentinel node was tumor positive. The size of the sentinel node metastasis was measured and classified as micrometastasis--2 mm or less, or macrometastasis--more than 2 mm. Sentinel and dissection specimen nodes were step-sectioned. Factors were analyzed for their association with additional nodal involvement, including stage, diameter, grade, absence or presence of vascular invasion of the primary tumor, and sentinel node metastasis size.
Tumor positive sentinel nodes were found in 46 groins and complementary lymph node dissection was performed. Nine of these 46 groins (20%) contained additional involved lymph nodes. On univariate and multivariate analyses the size of the sentinel node metastasis proved to be the only significant prognostic variable for additional lymph node involvement (each p = 0.02). None of the 15 groins with only micrometastasis in the sentinel node contained additional involved nodes.
In penile carcinoma additional nodal involvement was related to the size of the metastasis in the sentinel node. Sentinel node micrometastasis was not associated with other involved lymph nodes. This finding suggests that these patients can be spared complementary lymph node dissection.
大多数阴茎癌前哨淋巴结肿瘤阳性的患者因无其他受累淋巴结而无法从辅助性淋巴结清扫术中获益。我们分析了可能决定其他淋巴结受累情况的因素。
总共158例临床淋巴结阴性的阴茎癌患者接受了前哨淋巴结活检。当前哨淋巴结肿瘤阳性时，进行辅助性腹股沟淋巴结清扫术。测量前哨淋巴结转移灶的大小并分类为微转移（2毫米或更小）或宏转移（超过2毫米）。对前哨淋巴结和清扫标本中的淋巴结进行连续切片。分析包括分期、直径、分级、原发肿瘤有无血管侵犯以及前哨淋巴结转移灶大小等因素与其他淋巴结受累的相关性。
在46个腹股沟中发现前哨淋巴结肿瘤阳性，并进行了辅助性淋巴结清扫术。这46个腹股沟中有9个（20%）含有其他受累淋巴结。单因素和多因素分析显示，前哨淋巴结转移灶大小是其他淋巴结受累的唯一显著预后变量（p值均为0.02）。前哨淋巴结仅为微转移的15个腹股沟中均无其他受累淋巴结。
在阴茎癌中，其他淋巴结受累与前哨淋巴结转移灶大小有关。前哨淋巴结微转移与其他受累淋巴结无关。这一发现表明这些患者可免于辅助性淋巴结清扫术。
