Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida.
Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
J Urol. 2015 Sep;194(3):696-701. doi: 10.1016/j.juro.2015.03.090. Epub 2015 Mar 20.
Penile carcinoma with bilateral pelvic lymph node metastasis is a relatively rare condition with poor outcomes. There are little data available on optimal strategies for staging and treating this group of patients. We assessed factors predicting bilateral pelvic lymph node metastasis in patients with penile cancer and confirmed inguinal lymph node metastasis.
Multi-institutional data from a total of 4 centers in Europe, the People's Republic of China and the United States were retrospectively analyzed. Patients with penile carcinoma and inguinal lymph node metastasis who underwent bilateral pelvic lymphadenectomy were included in analysis. The Kaplan-Meier and log rank tests were used to express overall survival. Logistic regression was used for multivariate analysis of factors predicting bilateral pelvic lymph node metastasis. Cox regression was done in the multivariable analysis of overall survival.
We identified 140 patients with penile carcinoma who had confirmed pelvic lymph node metastasis. Of the patients 83 had bilateral inguinal lymph node metastasis and 64 underwent bilateral pelvic lymphadenectomy. Bilateral pelvic lymph node metastasis was observed in 16 patients (25%). The ROC of the total number of inguinal lymph node metastases and the detection of bilateral pelvic lymph node metastasis had an AUC of 0.76 (p = 0.002) with 95% sensitivity for the cutoff point of 4 inguinal nodes. On logistic regression analysis the detection of 4 or more positive inguinal nodes was the only independent predictor of bilateral pelvic lymph node metastasis (OR 14.0, CI 1.71-115). On Cox regression analysis 4 or more inguinal lymph node metastases, adjuvant chemotherapy, inguinal extraprostatic extension and bilateral procedures were associated with overall survival.
Patients with bilateral inguinal lymph node metastasis who are treated with unilateral pelvic lymphadenectomy should be considered for bilateral pelvic lymphadenectomy in the presence of 4 or more metastatic inguinal nodes.
阴茎癌伴双侧盆腔淋巴结转移是一种较为罕见的疾病，预后较差。目前关于该类患者的分期和治疗的最佳策略的数据很少。我们评估了预测阴茎癌患者双侧盆腔淋巴结转移的因素，并证实了腹股沟淋巴结转移。
对来自欧洲、中华人民共和国和美国的 4 个中心的多机构数据进行回顾性分析。纳入接受双侧盆腔淋巴结清扫术的阴茎癌伴腹股沟淋巴结转移患者进行分析。采用 Kaplan-Meier 和对数秩检验表示总生存情况。采用多因素分析预测双侧盆腔淋巴结转移的因素。采用 Cox 回归分析总生存的多因素分析。
我们确定了 140 例经证实有盆腔淋巴结转移的阴茎癌患者。其中 83 例患者有双侧腹股沟淋巴结转移，64 例行双侧盆腔淋巴结清扫术。16 例（25%）患者发现双侧盆腔淋巴结转移。总腹股沟淋巴结转移数和双侧盆腔淋巴结转移检测的 ROC 曲线的 AUC 为 0.76（p=0.002），截断点为 4 个腹股沟淋巴结时具有 95%的敏感性。在多因素回归分析中，检测到 4 个或更多阳性腹股沟淋巴结是双侧盆腔淋巴结转移的唯一独立预测因子（OR 14.0，95%CI 1.71-115）。在 Cox 回归分析中，4 个或更多腹股沟淋巴结转移、辅助化疗、腹股沟外扩延伸和双侧手术与总生存相关。
对于接受单侧盆腔淋巴结清扫术的双侧腹股沟淋巴结转移患者，如果存在 4 个或更多转移性腹股沟淋巴结，应考虑行双侧盆腔淋巴结清扫术。
