Department of Urology, University Medical Center Rostock; Rostock, Germany; Institute of Pathology, University Medical Center Rostock, Rostock, Germany; Department of Urology and Pediatric Urology, Schleswig-Holstein University Hospital (UK-SH), Campus Kiel, Kiel, Germany.
Dtsch Arztebl Int. 2018 Sep 28;115(39):646-652. doi: 10.3238/arztebl.2018.0646.
The incidence of penile cancer in Europe lies in the range of 0.9 to 2.1 cases per 100 000 persons per year. Carcinogenesis is associated with human papilloma virus (HPV) infection and with chronic inflammation.
This review is based on publications (2010-2017) retrieved by a selective search in PubMed and EMBASE and on the guidelines of the European Association of Urology, the European Society of Medical Oncology, the National Comprehensive Cancer Network, and the National Institute for Health and Care Excellence (NICE).
95% of cases of penile cancer are accounted for by squamous cell carcinoma, whose numerous subtypes have different clinical courses. Chronic preputial inflammation due to phimosis or lichen sclerosus is often associated with penile cancer. Circumcision lowers the risk of penile cancer (hazard ratio: 0.33). Maximally organ-preserving surgery with safety margins of no more than a few millimeters is the current therapeutic standard, because a local recurrence, if it arises, can still be treated locally with curative intent. Local radiotherapy can be performed in early stages. Lymphogenic metastasis must be treated with radical lymphadenectomy and adjuvant chemotherapy. Patients with clinically unremarkable inguinal lymph nodes nonetheless need invasive lymph node staging because of the high rate of lymphogenic micrometastasis.
Penile cancer is curable in all early stages with the appropriate treatment, but its prognosis depends crucially on the proper management of the regional (i.e., inguinal) lymph nodes. In many countries, the treatment of this rare disease entity has been centralized.
欧洲的阴茎癌发病率为每 100000 人每年 0.9 至 2.1 例。其发病机制与人类乳头瘤病毒（HPV）感染和慢性炎症有关。
本综述基于在 PubMed 和 EMBASE 中进行的选择性搜索检索到的出版物（2010-2017 年），并参考了欧洲泌尿外科学会、欧洲肿瘤内科学会、国家综合癌症网络和英国国家卫生与保健优化研究所（NICE）的指南。
95%的阴茎癌病例为鳞状细胞癌，其众多亚型具有不同的临床病程。由于包茎或硬化性苔藓引起的慢性包皮炎症常与阴茎癌有关。包皮环切术可降低阴茎癌的风险（风险比：0.33）。最大限度地保留器官且安全切缘不超过几毫米的手术是目前的治疗标准，因为如果局部复发，仍可以局部治疗治愈。早期可进行局部放疗。淋巴转移必须通过根治性淋巴结清扫术和辅助化疗进行治疗。尽管存在高淋巴微转移率，但临床无腹股沟淋巴结异常的患者仍需要进行侵袭性淋巴结分期。
在所有早期阶段，适当的治疗都可以治愈阴茎癌，但预后取决于区域（即腹股沟）淋巴结的正确管理。在许多国家，这种罕见疾病实体的治疗已集中化。
