Qu X Melody, Siemens D Robert, Louie Alexander V, Yip Darwin, Mahmud Aamer
Department of Oncology, Queen's University, Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, ON.
Department of Urology, Queen's University, Kingston General Hospital, Kingston, ON.
Can Urol Assoc J. 2018 Apr;12(4):119-125. doi: 10.5489/cuaj.4711. Epub 2017 Dec 22.
The ability to predict lymph node (LN) status is essential in the management of men with localized squamous cell carcinoma (SCC) of the penis. There has been limited external validation of available risk stratification tools, particularly in routine clinical care. The objective of this study was to evaluate the predictive variables of LN metastases within a large population-based cohort of patients.
In this population-based cohort study, surgical pathology reports were linked to the population-based Ontario Cancer Registry to identify all patients who were diagnosed with penile cancer in Ontario, Canada. Multivariable analyses were performed to evaluate predictive variables for LN involvement. Three contemporary risk stratification schemes used to predict LN status were analyzed by logistic regression.
The study included 380 localized penile SCC cases treated between 2000 and 2010. Sixty-three (17%) had pathologically confirmed LN metastases. Among these, 35 (56%) were diagnosed within three months of the initial penile SCC diagnosis and these patients had a worse five-year disease-specific survival (43%; 95% confidence interval [CI] 26-64) compared to patients who were diagnosed at a delayed LN dissection. On multivariable analysis, age (odds ratio [OR] 0.68; 95% CI 0.52-0.88), pathological stage (≥pT1b; OR 3.32; 95% CI 1.38-8.01), and tumour grade (Grade 2 OR 2.98; 95% CI 1.26-7.62; Grade 3 OR 3.97; 95% CI 1.32-11.9) were associated with an increased risk of LN metastases. Candidate risk stratification schemes demonstrated moderate to good property, with C-statistics ranging from 0.662-0.747.
Using a population-based cohort of penile cancer patients with a relatively low proportion of patients with pathologically confirmed LN involvement, we confirm and externally validate the importance of age, stage, and grade of the primary tumour in predicting nodal status.
预测淋巴结（LN）状态的能力对于阴茎局限性鳞状细胞癌（SCC）男性患者的管理至关重要。现有的风险分层工具的外部验证有限，尤其是在常规临床护理中。本研究的目的是评估一大群基于人群的患者队列中LN转移的预测变量。
在这项基于人群的队列研究中，手术病理报告与基于人群的安大略癌症登记处相关联，以识别加拿大安大略省所有被诊断为阴茎癌的患者。进行多变量分析以评估LN受累的预测变量。通过逻辑回归分析用于预测LN状态的三种当代风险分层方案。
该研究包括2000年至2010年间治疗的380例局限性阴茎SCC病例。六十三例（17%）有病理证实的LN转移。其中，35例（56%）在初次阴茎SCC诊断后的三个月内被诊断出来，与在延迟LN清扫时被诊断的患者相比，这些患者的五年疾病特异性生存率较差（43%；95%置信区间[CI]26 - 64）。在多变量分析中，年龄（比值比[OR]0.68；95%CI 0.52 - 0.88）、病理分期（≥pT1b；OR 3.32；95%CI 1.38 - 8.01）和肿瘤分级（2级OR 2.98；95%CI 1.26 - 7.62；3级OR 3.97；95%CI 1.32 - 11.9）与LN转移风险增加相关。候选风险分层方案显示出中等至良好的性能，C统计量范围为0.662 - 0.747。
在病理证实LN受累患者比例相对较低的基于人群的阴茎癌患者队列中，我们证实并在外部验证了原发性肿瘤的年龄、分期和分级在预测淋巴结状态方面的重要性。
