Urology Department, Hôtel-Dieu University Hospital Centre, Nantes, France.
J Urol. 2010 Jun;183(6):2227-32. doi: 10.1016/j.juro.2010.02.025.
The current penile cancer problem is defining lymph node invasion types for which inguinal lymphadenectomy is effective in terms of patient survival and the number of inguinal metastases beyond which combination therapy should be proposed. We evaluated survival of patients with penile cancer at high risk for lymph node invasion treated with inguinal lymphadenectomy.
A total of 114 patients underwent lymphadenectomy for penile cancer with no palpable inguinal lymph nodes (cN0) but at intermediate or high risk for lymph node invasion, or with 1 or several palpable inguinal lymph nodes (cN1-3). All patients were initially treated for primary penile cancer with clinical and pathological inguinal lymph node staging. Bilateral superficial superomedial, ipsilateral radical plus contralateral modified and bilateral radical procedures were done in 50 cN0, 35 cN1 and 29 cN2-3 cases, respectively. Overall specific and recurrence-free survival was calculated by Kaplan-Meier curves with differences calculated by the log rank test.
Five-year disease-free survival was 93.4%, 83.7%, 32% and 0% for stages cN0 to cN3, and 93.4%, 89.7%, 30.9% and 0% for stages pN0 to pN3, respectively, with a statistically significant difference for cN0-1 vs cN2-3 and pN0-1 vs pN2-3 (p <0.001). The recurrence rate was 10.5%, 10.3%, 32.6% and 30.0% for stages pN0 to pN3, respectively.
After inguinal lymphadenectomy specific and recurrence-free survival in cN1 and pN1 cases was comparable to that in cN0 and pN0 cases. The recurrence rate in the latter was higher than for other occult inguinal metastasis detection techniques. Only superomedial inguinal lymph nodes were studied, missing central and lateral superior zone occult metastasis. Survival was poor in patients with more than 2 lymph nodes invaded. In those cases chemotherapy protocols or chemotherapy combined with lymphadenectomy must be evaluated.
当前的阴茎癌问题在于定义淋巴结侵犯类型，以便确定哪些患者适合进行腹股沟淋巴结清扫术以提高生存率，以及哪些患者存在多个腹股沟转移灶需要联合治疗。本研究评估了接受腹股沟淋巴结清扫术治疗但存在高淋巴结侵犯风险的阴茎癌患者的生存情况。
共有 114 例无可触及腹股沟淋巴结（cN0）但存在中高危淋巴结侵犯风险或存在 1 或多个可触及腹股沟淋巴结（cN1-3）的阴茎癌患者接受了腹股沟淋巴结清扫术。所有患者均接受了原发性阴茎癌的治疗，并进行了临床和病理的腹股沟淋巴结分期。50 例 cN0 患者、35 例 cN1 患者和 29 例 cN2-3 患者分别接受了双侧superomedial 浅表清扫术、同侧 radical 加对侧 modified 根治术和双侧 radical 根治术。采用 Kaplan-Meier 曲线计算总生存率和无复发生存率，并通过对数秩检验比较差异。
cN0 至 cN3 各期的 5 年无病生存率分别为 93.4%、83.7%、32%和 0%，pN0 至 pN3 各期的 5 年无病生存率分别为 93.4%、89.7%、30.9%和 0%，cN0-1 与 cN2-3 及 pN0-1 与 pN2-3 之间存在统计学差异（p<0.001）。pN0 至 pN3 各期的复发率分别为 10.5%、10.3%、32.6%和 30.0%。
cN1 和 pN1 患者接受腹股沟淋巴结清扫术后的生存率和无复发生存率与 cN0 和 pN0 患者相似。后者的复发率高于其他隐匿性腹股沟转移检测技术。本研究仅研究了 superomedial 腹股沟淋巴结，遗漏了中央和外侧上区的隐匿性转移。存在 2 个以上淋巴结侵犯的患者生存情况较差。对于这些患者，需要评估化疗方案或化疗联合淋巴结清扫术的效果。
