Hungerhuber Edwin, Schlenker Boris, Karl Alexander, Frimberger Dominic, Rothenberger Karl-Heinz, Stief Christian G, Schneede Peter
Department of Urology, Klinikum Grosshadern, University of Munich, Munich, Germany.
Urology. 2006 Sep;68(3):621-5. doi: 10.1016/j.urology.2006.03.052. Epub 2006 Sep 18.
In penile carcinoma, the most reliable staging method for lymph node involvement remains radical dissection with its associated high morbidity. However, the patient's prognosis is closely associated with lymph node status, and radical dissection is potentially curative. We report our experience with surgical lymph node staging and evaluate which group of patients could be assigned to a wait-and-see strategy or dynamic sentinel node biopsy and which group should undergo groin dissection.
From 1979 to 2004, 56 consecutive patients with penile cancer underwent surgical inguinal lymph node staging. On the basis of the histopathologic results, we defined risk stratification into low, high, and intermediate-risk groups according to the clinical examination findings, stage, and grade.
Tumor stage (P = 0.019) and tumor grade (P <0.001) correlated significantly with lymph node status. Stratification into low (pT1G1, pT1G2), high (all G3 tumors), and intermediate-risk (all others) groups found 7.7% of low-risk patients with metastases. In the intermediate and high-risk groups, 28.6% and 75.0% had nodal metastases, respectively. Correlation with nodal involvement according to risk group was R2 = 0.608 (P <0.001).
Risk stratification might enable a modified staging strategy for lymph node status according to stage, grade, and clinical examination findings. Highly motivated low-risk patients could be included in a surveillance program; however, high-risk patients should undergo bilateral inguinal dissection. Dynamic sentinel lymph node biopsy might be encouraged for intermediate-risk patients in the future.
在阴茎癌中，对于淋巴结受累最可靠的分期方法仍是根治性切除术，但其相关发病率较高。然而，患者的预后与淋巴结状态密切相关，根治性切除术可能具有治愈性。我们报告了我们在手术性淋巴结分期方面的经验，并评估哪些患者群体可采用观察等待策略或动态前哨淋巴结活检，以及哪些患者群体应接受腹股沟淋巴结清扫术。
1979年至2004年，连续56例阴茎癌患者接受了腹股沟淋巴结手术分期。根据组织病理学结果，我们根据临床检查结果、分期和分级将风险分层定义为低、高和中风险组。
肿瘤分期（P = 0.019）和肿瘤分级（P <0.001）与淋巴结状态显著相关。分层为低风险组（pT1G1、pT1G2）、高风险组（所有G3肿瘤）和中风险组（所有其他情况），发现7.7%的低风险患者有转移。在中风险组和高风险组中，分别有28.6%和75.0%有淋巴结转移。根据风险组与淋巴结受累的相关性为R2 = 0.608（P <0.001）。
风险分层可能根据分期、分级和临床检查结果为淋巴结状态制定改良的分期策略。积极性高的低风险患者可纳入监测计划；然而，高风险患者应接受双侧腹股沟清扫术。未来可能鼓励对中风险患者进行动态前哨淋巴结活检。
