阴茎癌区域淋巴结的当代管理——提高生存率？
Contemporary management of regional nodes in penile cancer-improvement of survival?
机构信息
Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
出版信息
J Urol. 2014 Jan;191(1):68-73. doi: 10.1016/j.juro.2013.07.088. Epub 2013 Aug 2.
PURPOSE
The management of regional nodes of penile squamous cell carcinoma has changed with time due to improved knowledge about diagnosis and treatment. To determine whether changes in the treatment of regional nodes have improved survival, we compared contemporary 5-year cancer specific survival of patients with squamous cell carcinoma of the penis with that of patients in previous cohorts.
MATERIALS AND METHODS
In an observational cohort study of 1,000 patients treated during 56 years 944 were eligible for analysis. Tumors were staged according to the 2009 TNM classification, and patients were divided into 4 cohorts of 1956 to 1987, 1988 to 1993, 1994 to 2000 and 2001 to 2012, reflecting changes in clinical practice regarding regional nodes. Kaplan-Meier survival curves with the log rank test and Cox proportional hazards modeling were used to examine trends in 5-year cancer specific survival.
RESULTS
The 5-year cancer specific survival of patients with cN0 disease treated between 2001 and 2012 was 92% compared to 89% (1994 to 2000), 78% (1988 to 1993) and 85% (1956 to 1987). The 5-year cancer specific survival improved significantly since 1994, the year dynamic sentinel node biopsy was introduced, at 91% (1994 to 2012) vs 82% (1956 to 1993) (p = 0.021). This conclusion still holds after adjustment for pathological T stage and grade of differentiation (HR 2.46, p = 0.01). Extranodal extension, number of tumor positive nodes and pelvic involvement in node positive (pN+) cases were associated with worse 5-year cancer specific survival.
CONCLUSIONS
Despite less surgery being performed on regional nodes, 5-year cancer specific survival has improved in patients with cN0 disease. The number of tumor positive nodes, extranodal extension and pelvic involvement were highly associated with worse cancer specific survival in patients with pN+ disease. In this group other treatment strategies are needed as no improvement was observed.
目的
由于对诊断和治疗的认识不断提高，阴茎鳞状细胞癌区域淋巴结的管理方式也随之发生了变化。为了确定区域淋巴结治疗方法的改变是否提高了生存率，我们比较了阴茎鳞状细胞癌患者的当代 5 年癌症特异性生存率与以往队列患者的生存率。
材料与方法
在一项对 1000 例患者进行的 56 年观察队列研究中，944 例患者符合分析条件。肿瘤分期根据 2009 年 TNM 分期进行，患者分为 4 个队列，分别为 1956 年至 1987 年、1988 年至 1993 年、1994 年至 2000 年和 2001 年至 2012 年，反映了区域淋巴结治疗方面临床实践的变化。使用 Kaplan-Meier 生存曲线和对数秩检验以及 Cox 比例风险模型来检查 5 年癌症特异性生存率的趋势。
结果
2001 年至 2012 年治疗的 cN0 疾病患者的 5 年癌症特异性生存率为 92%，而 1994 年至 2000 年为 89%、1988 年至 1993 年为 78%、1956 年至 1987 年为 85%。自 1994 年引入动态前哨淋巴结活检以来，5 年癌症特异性生存率显著提高，91%（1994 年至 2012 年）比 82%（1956 年至 1993 年）（p=0.021）。在调整病理 T 分期和分化程度后，这一结论仍然成立（HR 2.46，p=0.01）。淋巴结外扩散、肿瘤阳性淋巴结数量和盆腔受累是淋巴结阳性（pN+）病例 5 年癌症特异性生存率较差的相关因素。
结论
尽管区域淋巴结的手术减少，但 cN0 疾病患者的 5 年癌症特异性生存率有所提高。在 pN+疾病患者中，肿瘤阳性淋巴结数量、淋巴结外扩散和盆腔受累与癌症特异性生存率较差高度相关。在这一组中，需要采取其他治疗策略，因为没有观察到改善。
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