Department of Urology, University College London Hospital, London, UK.
BJU Int. 2013 May;111(6):970-6. doi: 10.1111/j.1464-410X.2012.11773.x. Epub 2013 Jan 29.
WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: The European Association of Urology guidelines identify lichen sclerosus (LS) as a strong risk factor for penile squamous cell carcinoma (pSCC). However, this statement is based on the findings of case-control studies (Level of Evidence 2a) and a direct causal relationship between LS/balanitis xerotica obliterans (BXO) and pSCC remains to be established. Firm guidelines with respect to the appropriate follow-up policy for LS/BXO are lacking, whereas the impact of synchronous LS/BXO on the prognosis of pSCC remains to be determined. The presence of histologically-confirmed synchronous LS/BXO in patients diagnosed with pSCC is relatively high, although it is not associated with an increased risk of adverse histopathological features. LS/BXO can develop in extragenital skin grafts used for reconstruction after organ-sparing surgery for pSCC.
To determine the rate of lichen sclerosus/balanitis xerotica obliterans (LS/BXO) in patients with penile squamous cell carcinoma (pSCC) and establish whether the presence of LS/BXO is associated with adverse histopathological features of pSCC. To report the phenomenon of LS involving non-genital skin grafts in patients who underwent organ-sparing surgery and split-skin graft (SSG) reconstruction
Between January 2002 and January 2010, 223 men underwent surgical treatment for pSCC. A group of 52 patients with histologically-confirmed synchronous LS was identified (group A; overall rate of LS/BXO = 23.3%) and compared with a group of patients without synchronous LS (group B; n = 171; 76.7%). A subgroup of patients who underwent surgical excision and SSG reconstruction was also identified The histology reports of graft biopsies obtained during follow-up were reviewed and the rate of LS involving the graft was also recorded.
Mean (range) age at diagnosis was 60.9 (34-81) years and 60.7 (28-89) years for groups A and B, respectively (P = 0.958). The mean (range) duration of follow-up was 38.3 (4-92) months for group A and 45.5 (4-107) months for group B (P = 0.162) No statistically significant differences were noted between groups A and B in terms of tumour grade (P = 0.091), stage (P = 0.697), presence of lymphovascular invasion (P = 0.333), histological subtype (P = 0.107), associated carcinoma in situ (P = 0.246) or nodal status at initial diagnosis (P = 0.555). In the subgroup of 188 patients who underwent SSG reconstruction, 41 (21.8%) patients had histologically-confirmed synchronous LS; in this subgroup, 26 (13.8%) patients underwent graft biopsy during follow-up. Genital LS involving the graft was identified in seven specimens, although none of these seven cases had associated recurrent pSCC.
The presence of histologically-confirmed synchronous LS in patients with pSCC is relatively high but is not associated with increased rates of adverse histopathological features, including carcinoma in situ. LS can develop in extragenital skin grafts, although its association with the long-term risk for recurrent pSCC is not apparent in the present study.
确定阴茎鳞状细胞癌（pSCC）患者中硬化性苔藓/萎缩性硬化性苔藓（LS/BXO）的发生率，并确定 LS/BXO 的存在是否与 pSCC 的不良组织病理学特征相关。报告接受保器官手术和皮片移植（SSG）重建的患者中非生殖器皮肤移植物中 LS 的现象。
2002 年 1 月至 2010 年 1 月期间，223 名男性接受了 pSCC 的手术治疗。确定了一组 52 例经组织学证实的同步 LS 患者（A 组；LS/BXO 的总发生率为 23.3%），并与一组无同步 LS 的患者（B 组；n=171；76.7%）进行比较。还确定了一组接受手术切除和 SSG 重建的患者。回顾随访期间获得的移植物活检的组织学报告，并记录移植物中 LS 的发生率。
A 组和 B 组的诊断时年龄分别为 60.9（34-81）岁和 60.7（28-89）岁（P=0.958）。A 组的中位（范围）随访时间为 38.3（4-92）个月，B 组为 45.5（4-107）个月（P=0.162）。A 组和 B 组在肿瘤分级（P=0.091）、分期（P=0.697）、脉管侵犯存在（P=0.333）、组织学亚型（P=0.107）、相关原位癌（P=0.246）或初始诊断时的淋巴结状态（P=0.555）方面无统计学显著差异。在接受 SSG 重建的 188 名患者亚组中，有 41 名（21.8%）患者经组织学证实存在同步 LS；在该亚组中，有 26 名（13.8%）患者在随访期间进行了移植物活检。在 7 个标本中发现了生殖器 LS 累及移植物，但这 7 例均无相关的复发性 pSCC。
pSCC 患者中经组织学证实的同步 LS 发生率相对较高，但与包括原位癌在内的不良组织病理学特征的发生率增加无关。LS 可发生在非生殖器皮肤移植物中，但在本研究中，其与长期复发性 pSCC 的风险之间的关联尚不清楚。
