局部晚期阴茎鳞状细胞癌患者围手术期化疗的临床结局：多中心分析结果。
Clinical Outcomes of Perioperative Chemotherapy in Patients With Locally Advanced Penile Squamous-Cell Carcinoma: Results of a Multicenter Analysis.
机构信息
Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
McMaster University, Hamilton, Ontario, Canada.
出版信息
Clin Genitourin Cancer. 2017 Oct;15(5):548-555.e3. doi: 10.1016/j.clgc.2017.02.002. Epub 2017 Feb 27.
BACKGROUND
The prognosis of patients with locally advanced penile squamous-cell carcinoma is primarily related to the extent of lymph node metastases. Surgery alone yields suboptimal results, and there is a paucity of data on these patients' outcomes.
PATIENTS AND METHODS
This retrospective study evaluated patients who received neoadjuvant or adjuvant chemotherapy from 1990 onward at 12 centers. Cox models were used to investigate prognostic factors for relapse-free survival and overall survival (OS).
RESULTS
Among the 201 included patients, 39 (19.4%) had disease of T3-4 and N0 clinical stage; the remaining patients had clinical lymph node involvement (cN+). Ninety-four patients received neoadjuvant chemotherapy (group 1), 78 received adjuvant chemotherapy (group 2), and 21 received both (group 3). Eight patients for whom the timing of perioperative chemotherapy administration was unavailable were included in the Cox analyses. Forty-three patients (21.4%) received chemoradiation. Multivariate analysis for OS (n = 172) revealed bilateral disease (P = .035) as a negative prognostic factor, while pelvic cN+ tended to be nonsignificantly associated with decreased OS (P = .076). One-year relapse-free survival was 35.6%, 60.6%, and 45.1% in the 3 groups, respectively. One-year OS was 61.3%, 82.2%, and 75%, respectively. No significant differences were seen on univariable analyses for OS between the groups (P = .45). Platinum type of chemotherapy and chemoradiation were not significantly associated with any outcome analyzed.
CONCLUSION
Benchmark survival estimates for patients receiving perioperative chemotherapy for locally advanced penile squamous-cell carcinoma have been provided, with no substantial differences observed between neoadjuvant and adjuvant administration. This analysis may result in improved patient information, although prospective studies are warranted.
背景
局部晚期阴茎鳞癌患者的预后主要与淋巴结转移程度有关。单独手术的效果并不理想，关于这些患者的结局的数据很少。
患者和方法
本回顾性研究评估了 1990 年以来 12 个中心接受新辅助或辅助化疗的患者。Cox 模型用于研究无复发生存和总生存（OS）的预后因素。
结果
在 201 例纳入患者中，39 例（19.4%）疾病为 T3-4 和 N0 临床分期；其余患者有临床淋巴结受累（cN+）。94 例患者接受新辅助化疗（组 1），78 例接受辅助化疗（组 2），21 例同时接受新辅助和辅助化疗（组 3）。8 例患者的围手术期化疗时间不可用，纳入 Cox 分析。43 例（21.4%）患者接受放化疗。OS 的多变量分析（n=172）显示双侧疾病（P=0.035）是一个负面预后因素，而骨盆 cN+则与 OS 降低呈负相关趋势（P=0.076）。3 组的 1 年无复发生存率分别为 35.6%、60.6%和 45.1%。1 年 OS 率分别为 61.3%、82.2%和 75%。单变量分析显示，3 组间 OS 无显著差异（P=0.45）。化疗类型和放化疗与任何分析的结果均无显著相关性。
结论
为接受局部晚期阴茎鳞癌围手术期化疗的患者提供了生存估计的基准，新辅助和辅助给药之间没有观察到显著差异。虽然需要前瞻性研究，但这种分析可能会改善患者信息。
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