Sanchez Diego F, Soares Fernando, Alvarado-Cabrero Isabel, Cañete Sofía, Fernández-Nestosa María José, Rodríguez Ingrid M, Barreto José, Cubilla Antonio L
Instituto de Patología e Investigación, Asunción, Paraguay; Facultad de Ciencias Médicas, UNA, Asunción, Paraguay.
Department of Anatomic Pathology, AC Camargo Cancer Center, São Paulo, Brazil.
Semin Diagn Pathol. 2015 May;32(3):222-31. doi: 10.1053/j.semdp.2014.12.017. Epub 2014 Dec 27.
Pathologists' contribution in the determination of prognosis in invasive penile squamous cell carcinoma is crucial. The TNM staging system is based on the identification of pathological data. There are multiple pathologically based factors believed to be important in relation to the rates of regional inguinal lymph node and specific cancer death. Among them are tumor site, size, histological subtypes, thickness or anatomical level of invasion, tumor front, and vascular or perineural invasion. The identification of these factors determines the prognostic profile of patients with penile cancer. These factors are used for the construction of pathological risk groups, prognostic index, or nomograms and are helpful in the prediction of nodal metastasis or patients' outcome. This review will describe in detail the influential pathological prognostic factors present in each tumor category emphasizing the impact of especial histological subtypes in tumor spread and final outcome. There are few studies comprehensibly addressing the relation of tumor morphology and prognosis according to histological types. We are summarizing findings of prognostic factors in 3 different series for the most common types and individual series in more recently described tumor entities. We had found a broad correlation of special subtypes of penile squamous cell carcinomas that made regional nodal status and final outcome predictable according to histological features of the tumor. These findings permitted grouping special subtypes of squamous cell carcinomas into prognosis risk groups of low, intermediate, and high. In the first category of excellent prognoses are the usual grade I, verrucous, papillary NOS, pseudohyperplastic and cuniculatum carcinomas. In the second group, there are the grade II usual, mixed and warty carcinomas. The third category of tumors, with the worst prognosis is composed of high grade usual, basaloid, warty-basaloid, papillary basaloid, and sarcomatoid carcinomas. We found that subtyping of penile squamous cell carcinoma is important to determine risk for nodal metastasis and patients' survival.
病理学家在浸润性阴茎鳞状细胞癌预后判定中的贡献至关重要。TNM分期系统基于病理数据的识别。有多种基于病理的因素被认为与腹股沟区域淋巴结转移率和特定癌症死亡率相关。其中包括肿瘤部位、大小、组织学亚型、浸润厚度或解剖层面、肿瘤前沿以及血管或神经周围浸润。这些因素的识别决定了阴茎癌患者的预后特征。这些因素用于构建病理风险组、预后指数或列线图，有助于预测淋巴结转移或患者的预后。本综述将详细描述每种肿瘤类别中存在的有影响的病理预后因素，强调特殊组织学亚型对肿瘤扩散和最终结局的影响。很少有研究全面探讨肿瘤形态与组织学类型预后之间的关系。我们总结了3个不同系列中最常见类型的预后因素以及最近描述的肿瘤实体的个别系列的研究结果。我们发现阴茎鳞状细胞癌的特殊亚型与区域淋巴结状态和最终结局之间存在广泛关联，可根据肿瘤的组织学特征进行预测。这些发现允许将鳞状细胞癌的特殊亚型分为低、中、高预后风险组。预后极佳的第一类包括常见的I级、疣状、乳头型NOS、假增生性和漏斗状癌。第二类包括II级常见、混合型和疣状癌。预后最差的第三类肿瘤由高级别常见、基底样、疣状基底样、乳头基底样和肉瘤样癌组成。我们发现阴茎鳞状细胞癌的亚型分类对于确定淋巴结转移风险和患者生存率很重要。
