Leijte Joost A P, Kirrander Peter, Antonini Ninja, Windahl Torgny, Horenblas Simon
Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Eur Urol. 2008 Jul;54(1):161-8. doi: 10.1016/j.eururo.2008.04.016. Epub 2008 Apr 15.
Current follow-up recommendations for patients with penile carcinoma are based on small numbers of patients.
To give further insight into the recurrence patterns of penile carcinoma in different treatment settings and provide recommendations for follow up. DESIGNS, SETTING, AND PARTICIPANTS: In this retrospective study, we analysed 700 patients from two referral centres for penile carcinoma for recurrences.
Recurrences were categorized as local, regional, or distant. The rate of local recurrences was compared between patients undergoing penile-preserving treatments and partial/total amputation. Regional recurrences were compared between patients surgically staged as pN0 or pN+ and clinically node-negative (cN0) patients subjected to a wait-and-see policy. The total recurrence rate, type of recurrence, time to recurrence, and survival were calculated.
205 out of 700 patients (29.3%) had a recurrence, consisting of 18.6% local, 9.3% regional, and 1.4% distant recurrences. Of the recurrences, 92.2% occurred within 5 yr after primary treatment. All regional and distant recurrences occurred within 50 and 16 mo, respectively. The local recurrence rate was 27.7% after penile-preserving therapy and 5.3% after amputation. The regional recurrence rate was 2.3% in patients staged as pN0, 19.1% in patients staged as pN+, and 9.1% in patients undergoing a wait-and-see policy. The 5-yr disease-specific survival was 92% after a local recurrence and 32.7% after a regional recurrence. All patients with a distant recurrence died within 22 mo. Although the number of analysed patients is substantial, the results do not necessarily reflect those of other centres using different techniques for the management of penile carcinoma.
Patients undergoing penile-preserving therapy, patients surgically staged as pN+, and those undergoing a wait-and-see policy for the nodal status are at high risk of developing a recurrence. Follow-up recommendations are provided based on the risk and impact on survival of a recurrence.
目前针对阴茎癌患者的随访建议是基于少量患者得出的。
进一步深入了解阴茎癌在不同治疗情况下的复发模式，并提供随访建议。设计、地点和参与者：在这项回顾性研究中，我们分析了来自两个阴茎癌转诊中心的700例患者的复发情况。
复发分为局部、区域或远处复发。比较了接受保留阴茎治疗和部分/全阴茎切除的患者的局部复发率。比较了手术分期为pN0或pN+的患者与采取观察等待策略的临床淋巴结阴性（cN0）患者的区域复发情况。计算了总复发率、复发类型、复发时间和生存率。
700例患者中有205例（29.3%）复发，其中局部复发占18.6%，区域复发占9.3%，远处复发占1.4%。在复发患者中，92.2%在初次治疗后5年内发生。所有区域和远处复发分别发生在50个月和16个月内。保留阴茎治疗后局部复发率为27.7%，阴茎切除后为5.3%。手术分期为pN0的患者区域复发率为2.3%，pN+患者为19.1%，采取观察等待策略的患者为9.1%。局部复发后5年疾病特异性生存率为92%，区域复发后为32.7%。所有远处复发患者均在22个月内死亡。虽然分析的患者数量可观，但结果不一定反映其他采用不同阴茎癌管理技术的中心的结果。
接受保留阴茎治疗的患者、手术分期为pN+的患者以及对淋巴结状态采取观察等待策略的患者复发风险较高。根据复发风险和对生存的影响提供了随访建议。
