Meijer Richard P, Boon Tom A, van Venrooij Ger E P M, Wijburg Carl J
Department of Urology, University Medical Center, Utrecht, The Netherlands.
Urology. 2007 Apr;69(4):759-62. doi: 10.1016/j.urology.2007.01.023.
Although in many cases of penile carcinoma, laser therapy has become the standard treatment, opinion still differs regarding the risks related to the relatively high rate of recurrence that accompanies this form of treatment. In this study, we reviewed the results of neodymium:yttrium-aluminum-garnet laser treatment of 44 consecutive patients with penile carcinoma in our institution from 1986 to 2003.
We created five groups, on the basis of the T stage and grade of the tumor. Of the 44 patients, 21 had Stage T1, 17 had Stage T2, and 6 had carcinoma in situ.
Local disease recurrence (in the treated area) occurred in 48% of the treated patients, and in 20% of the patients, the first recurrence was elsewhere on the glans penis. These were subsequently treated by laser therapy or partial amputation. In 10 cases, nodal metastases were found. Eight of these cases were Stage T2. Our results suggest a stronger prognostic role for the primary T stage of the tumor than for the tumor grade, with respect to the risk of nodal metastasis.
From the high recurrence rate in our series, we decided to perform a wider initial laser excision and to diminish the number of retreatments to less than three. We also now believe that laser therapy is best for Stage Tis and T1 tumors exclusively. Only selected patients with T2 tumors should be treated in combination with early lymph node resection.
尽管在许多阴茎癌病例中，激光治疗已成为标准治疗方法，但对于这种治疗形式伴随的相对较高复发率相关风险，意见仍存在分歧。在本研究中，我们回顾了1986年至2003年期间在我们机构对44例连续性阴茎癌患者进行钕：钇铝石榴石激光治疗的结果。
我们根据肿瘤的T分期和分级创建了五组。44例患者中，21例为T1期，17例为T2期，6例为原位癌。
48%的接受治疗患者出现局部疾病复发（在治疗区域），20%的患者首次复发发生在阴茎头的其他部位。这些患者随后接受了激光治疗或部分截肢。10例患者发现有淋巴结转移。其中8例为T2期。我们的结果表明，就淋巴结转移风险而言，肿瘤的原发T分期比肿瘤分级具有更强的预后作用。
鉴于我们系列研究中的高复发率，我们决定进行更广泛的初始激光切除，并将再次治疗次数减少至少于三次。我们现在还认为，激光治疗仅最适合Tis期和T1期肿瘤。只有选定的T2期肿瘤患者应结合早期淋巴结切除术进行治疗。
