阴茎癌腹股沟淋巴结清扫术后淋巴结获取数量作为总生存的预测指标

Lymph node yield as a predictor of overall survival following inguinal lymphadenectomy for penile cancer.

作者信息

Soodana-Prakash Nachiketh, Koru-Sengul Tulay, Miao Feng, Lopategui Diana M, Savio Luis F, Moore Kevin J, Johnson Taylor A, Alameddine Mahmoud, Barboza Marcelo Panizzutti, Parekh Dipen J, Punnen Sanoj, Gonzalgo Mark L, Ritch Chad R

机构信息

Department of Urology, University of Miami, Miller School of Medicine, Miami, FL.

Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL.

出版信息

Urol Oncol. 2018 Oct;36(10):471.e19-471.e27. doi: 10.1016/j.urolonc.2018.07.010. Epub 2018 Aug 22.

DOI:10.1016/j.urolonc.2018.07.010

PMID:30143385

Abstract

OBJECTIVE

To determine whether a specific lymph node yield (LNY) affects overall survival (OS) in patients with penile cancer.

MATERIALS AND METHODS

Using the National Cancer Database, we identified 364 men diagnosed with pSCC who underwent ILND between 2004 and 2013. Men diagnosed on autopsy or at the time of death, patients with preoperative chemotherapy or radiotherapy, M+ and N3 disease, or with less than 3-month of follow-up were excluded. Kaplan-Meier analysis was used to compare Overall Survival (OS). A multivariable Cox regression model was developed to assess predictors of OS.

RESULTS

The median number of LN retrieved was 16 (IQR: 9-23). There was no significant difference in race, stage, grade for men with LNY ≤15 vs. >15. However, men with LNY ≤15 were significantly older than those with LNY >15 (65 vs. 59 years, p<0.001). On multivariable analysis, radical surgery, age, N+ disease, and LNY ≤15 were independent predictors of worse OS. Patients with LNY ≤15 showed significantly worse 5-year OS versus those with LNY >15 (49% vs. 67%, p=0.008). Nodal density (ND) ≥12.5% was also associated with decreased 5-year OS versus ND <12.5% (31% vs. 70%, p<0.0001).

CONCLUSIONS

LNY following ILND for pSCC appears to be an independent predictor of OS. A total LNY of >15 following ILND may have a beneficial impact on OS and serve as the threshold for defining an adequate ILND.

摘要

目的

确定特定的淋巴结收获量（LNY）是否会影响阴茎癌患者的总生存期（OS）。

材料与方法

利用国家癌症数据库，我们识别出364例在2004年至2013年间接受腹股沟淋巴结清扫术（ILND）的阴茎鳞状细胞癌（pSCC）男性患者。排除尸检诊断或死亡时诊断的男性、接受术前化疗或放疗的患者、M+和N3期疾病患者或随访时间少于3个月的患者。采用Kaplan-Meier分析比较总生存期（OS）。建立多变量Cox回归模型以评估OS的预测因素。

结果

回收的淋巴结中位数为16个（四分位间距：9 - 23个）。LNY≤15与LNY>15的男性在种族、分期、分级方面无显著差异。然而，LNY≤15的男性比LNY>15者年龄显著更大（65岁对59岁，p<0.001）。多变量分析显示，根治性手术、年龄、N+疾病和LNY≤15是OS较差的独立预测因素。LNY≤15的患者5年总生存率显著低于LNY>15的患者（49%对67%，p = 0.008）。淋巴结密度（ND）≥12.5%与ND<12.5%相比，5年总生存率也降低（31%对70%，p<0.0001）。