Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
J Urol. 2011 Mar;185(3):888-93. doi: 10.1016/j.juro.2010.10.059. Epub 2011 Jan 15.
We investigated the treatment results and outcomes of patients with pathological node positive penile carcinoma who experienced an inguinal recurrence after therapeutic lymphadenectomy, and determined the clinicopathological features predictive of such recurrences.
Data of 161 patients with pN+ penile carcinoma were analyzed. Ipsilateral postoperative radiotherapy was given if histopathology revealed 2 or more metastases and/or extranodal extension. Medium observed followup was 60 months. The 5-year incidence of inguinal recurrence was estimated using a competing risk analysis considering death a competing risk.
An inguinal recurrence developed in 26 patients following lymphadenectomy after a median of 5.3 months. The overall estimated 5-year inguinal recurrence rate was 16%. Of the 26 patients with inguinal recurrence ipsilateral adjuvant radiotherapy was indicated in 22 but given in 11. The other 11 patients had recurrence in the groin before the start of adjuvant radiotherapy. Median survival after inguinal recurrence was 4.5 months. Only 2 of 26 patients (8%) underwent successful salvage after inguinal recurrence. Pronounced differences in estimated recurrence rates were found among several clinicopathological variables indicating extensive penile cancer. Patients with 3 or more unilateral metastatic inguinal nodes and/or extranodal extension and/or pelvic nodal involvement defined a subgroup with high risk pN+ penile cancer.
Most inguinal recurrence following therapeutic lymphadenectomy in pN+ penile carcinoma occurs within a short time. Patients experiencing such a recurrence have a poor outcome with limited salvage options. Patients with 3 or more unilateral metastatic inguinal nodes and/or extranodal extension and/or pelvic nodal involvement represent a high risk group that may benefit from multimodality treatment.
我们研究了接受治疗性淋巴结清扫术后出现腹股沟复发的病理淋巴结阳性阴茎癌患者的治疗结果和结局，并确定了预测此类复发的临床病理特征。
分析了 161 例 pN+ 阴茎癌患者的数据。如果组织病理学显示有 2 个或更多转移灶和/或淋巴结外扩展，则给予同侧术后放疗。中位观察随访时间为 60 个月。采用竞争风险分析考虑死亡为竞争风险来估计腹股沟复发的 5 年发生率。
161 例患者中有 26 例在淋巴结清扫后 5.3 个月中位数时间出现腹股沟复发。总体估计 5 年腹股沟复发率为 16%。在 26 例腹股沟复发的患者中，22 例有同侧辅助放疗指征，但仅 11 例接受了辅助放疗。其他 11 例患者在开始辅助放疗前腹股沟复发。腹股沟复发后中位生存时间为 4.5 个月。26 例患者中仅有 2 例（8%）在腹股沟复发后成功挽救。几个临床病理变量表明广泛的阴茎癌，估计复发率存在显著差异。有 3 个或更多单侧转移性腹股沟淋巴结和/或淋巴结外扩展和/或盆腔淋巴结受累的患者定义为具有高风险 pN+ 阴茎癌的亚组。
治疗性淋巴结清扫术后 pN+ 阴茎癌的腹股沟复发大多发生在短时间内。经历这种复发的患者预后不良，挽救选择有限。有 3 个或更多单侧转移性腹股沟淋巴结和/或淋巴结外扩展和/或盆腔淋巴结受累的患者代表一个高风险组，可能受益于多模式治疗。
