Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida.
Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida.
J Urol. 2017 Dec;198(6):1346-1352. doi: 10.1016/j.juro.2017.06.076. Epub 2017 Jun 23.
To our knowledge it is unknown whether concomitant inguinal lymph node dissection at the time of penectomy improves outcomes in patients with penile cancer. We analyzed predictors of regional recurrence as well as disease specific survival based on time of inguinal lymph node dissection. We also determined an optimal time to perform inguinal lymph node dissection.
We reviewed the records of 84 consecutive patients with available nodal pathology findings. Recurrence-free and disease specific survival was estimated using the Kaplan-Meier method. Optimal time to inguinal lymph node dissection was assessed by ROC curves and used for dichotomization. Cox proportional HRs were used to identify predictors of regional recurrence after inguinal lymph node dissection.
A total of 47 (56%) and 37 patients (44%) presented with cN0 and cN+ disease, respectively, during a median followup of 21 months. A cutoff point of 3 months to perform inguinal lymph node dissection was used to dichotomize the cohort into early vs delayed groups. Early dissection in 51 men demonstrated 5-year recurrence-free survival of 77% vs 37.8% in 33 who underwent delayed dissection. Positive node disease (HR 23.2, 95% CI 2.98-181.2) and early inguinal lymph node dissection (HR 0.48, 95% CI 0.21-0.98) were predictors of regional recurrence. Five-year disease specific survival was 64.1% and 39.5% in the early and late dissection groups, respectively.
Three months appears to be an optimal window for performing inguinal lymph node dissection. While prospective trials are needed to define the role of upfront groin dissection, our results may help delineate patterns of referral and timing of inguinal lymph node dissection in patients with penile cancer.
据我们所知，阴茎癌患者行阴茎切除术时同时进行腹股沟淋巴结清扫是否能改善预后尚不清楚。我们分析了基于腹股沟淋巴结清扫时间的局部复发和疾病特异性生存的预测因素。我们还确定了进行腹股沟淋巴结清扫的最佳时间。
我们回顾了 84 例连续患者的记录，这些患者有可供分析的淋巴结病理结果。使用 Kaplan-Meier 方法估计无复发生存率和疾病特异性生存率。通过 ROC 曲线评估腹股沟淋巴结清扫的最佳时间，并用于二分类。使用 Cox 比例 HR 来确定腹股沟淋巴结清扫后局部复发的预测因素。
在中位随访 21 个月期间，共有 47 例（56%）和 37 例（44%）患者分别表现为 cN0 和 cN+疾病。将 3 个月的时间作为进行腹股沟淋巴结清扫的时间点来将队列分为早期和延迟组。51 例早期行腹股沟淋巴结清扫的患者 5 年无复发生存率为 77%，而 33 例延迟行腹股沟淋巴结清扫的患者为 37.8%。阳性淋巴结疾病（HR 23.2，95%CI 2.98-181.2）和早期腹股沟淋巴结清扫（HR 0.48，95%CI 0.21-0.98）是局部复发的预测因素。5 年疾病特异性生存率分别为早期和晚期组的 64.1%和 39.5%。
3 个月似乎是进行腹股沟淋巴结清扫的最佳时间窗口。虽然需要前瞻性试验来确定 upfront groin dissection 的作用，但我们的结果可能有助于描绘阴茎癌患者腹股沟淋巴结清扫的转诊模式和时间安排。
