Malhotra Sameer M, Rouse Robert V, Azzi Raymond, Reese Jeffrey
Department of Urology and Pathology, Stanford University Medical Center, Palo Alto, California, USA.
Can J Urol. 2009 Dec;16(6):4895-9.
In patients with penile squamous cell carcinomas (SCCs), lymphadenectomy can be curative and should be considered in cases deemed high risk for metastatic spread to regional lymph nodes. Management of patients without palpable lymphadenopathy remains controversial. Current guidelines for T1 penile SCCs based on previous studies have suggested that moderately differentiated tumors are at low risk for metastatic disease; however given our experience with such patients we sought to examine whether such tumors were truly observable or should be treated more aggressively.
A retrospective chart review of penile cancer cases at three institutions was performed. All slides of patients diagnosed with T1 lesions were rereviewed by our reference pathologists to confirm the original diagnosis and stage. These patients were also reviewed regarding lymphadenectomy results and clinical outcomes.
Between 1988 and 2004, a total of 34 cases of SCC of the penis were identified, of which 10 were stage T1. Of these 10 cases, seven had moderately differentiated carcinoma without vascular invasion on pathological evaluation. Metastatic disease was present in one patient at the time of diagnosis and subsequently developed in three of the remaining six patients during follow up. Thus a total of 4 (57%) of the patients developed metastatic disease.
Current management protocols place moderately differentiated T1 penile squamous carcinoma without vascular invasion in a low risk category for metastatic disease. As such, expectant management is currently offered as a primary option for these patients. Our experience suggests that patients in this category are in fact at higher risk for metastatic disease, and may be offered early groin dissection in place of expectant management.
对于阴茎鳞状细胞癌（SCC）患者，淋巴结清扫术可能具有治愈性，对于被认为区域淋巴结转移风险高的病例应考虑进行该手术。对于无可触及淋巴结肿大的患者的管理仍存在争议。基于先前研究的当前T1期阴茎SCC指南表明，中分化肿瘤发生转移疾病的风险较低；然而，鉴于我们对这类患者的经验，我们试图研究这类肿瘤是否真的可观察，或者是否应采取更积极的治疗。
对三家机构的阴茎癌病例进行回顾性病历审查。我们的参考病理学家对所有诊断为T1期病变患者的切片进行重新审查，以确认原始诊断和分期。还对这些患者的淋巴结清扫结果和临床结局进行了审查。
1988年至2004年期间，共确定了34例阴茎SCC病例，其中10例为T1期。在这10例病例中，7例在病理评估中为无血管侵犯的中分化癌。1例患者在诊断时出现转移疾病，其余6例患者中有3例在随访期间随后发生转移。因此，共有4例（57%）患者发生转移疾病。
当前的管理方案将无血管侵犯的中分化T1期阴茎鳞状癌归为转移疾病低风险类别。因此，目前对这些患者主要提供观察等待管理。我们的经验表明，这类患者实际上发生转移疾病的风险较高，可能应进行早期腹股沟清扫术而非观察等待管理。
