Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada; Department of Urology, European Institute of Oncology, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy, Vita-Salute San Raffaele University, Milan, Italy.
Urol Oncol. 2019 Sep;37(9):578.e11-578.e19. doi: 10.1016/j.urolonc.2019.05.024. Epub 2019 Jul 8.
We analyzed adherence rates to contemporary guidelines regarding inguinal lymph node dissection (ILND) for squamous cell carcinoma of the penis, as well as ILND association with cancer specific mortality (CSM), and complication rates.
Within the Surveillance, Epidemiology, and End Results and the National Inpatient Sample databases, 943 and 317 nonmetastatic penile cancer patients (1998-2015) were respectively identified. Multivariable analyses focused on ILND rates, CSM, and complication rates. Inverse probability of treatment weighting adjustment was used in CSM analyses.
Within the Surveillance, Epidemiology, and End Results database, ILND was performed in 233 (24.7%) patients. ILND rates did not vary over time (P = 0.2). In the overall cohort (n = 943), ILND was an independent predictor of lower CSM (hazards ratio [HR]: 0.42; P < 0.001). In Multivariable CSM analyses stratified according to N-stage, ILND was associated with lower CSM in N1 (HR: 0.25; P < 0.001) and N2-3 (HR: 0.42; P = 0.01), but not in N0 patients. Within the National Inpatient Sample database, presence of LN invasion (LNI) was associated with longer hospitalization (odds ratio: 1.27, P = 0.01), but not with higher complications or in-hospital mortality.
The adherence to guidelines for ILND was low (24.7%), and did not change over time. Nonetheless, a CSM benefit related to ILND was observed in N1, N2, and N3 patients. Complication rates and in-hospital mortality did not differ according to LNI. However, hospital stay may be longer in LNI patients. Finally, it should be noted that lack of distinction between clinical and pathological N-stage represents an important limitation.
我们分析了当代腹股沟淋巴结清扫术（ILND）治疗阴茎鳞癌的指南遵循率，以及 ILND 与癌症特异性死亡率（CSM）和并发症发生率的关系。
在监测、流行病学和结果数据库（Surveillance, Epidemiology, and End Results，SEER）和国家住院患者样本数据库（National Inpatient Sample，NIS）中，分别确定了 943 例和 317 例非转移性阴茎癌患者（1998-2015 年）。多变量分析侧重于 ILND 率、CSM 和并发症发生率。在 CSM 分析中使用了治疗反概率加权调整。
在 SEER 数据库中，有 233 例（24.7%）患者接受了 ILND。ILND 率随时间变化没有差异（P=0.2）。在整个队列（n=943）中，ILND 是 CSM 降低的独立预测因素（风险比 [HR]：0.42；P<0.001）。在根据 N 分期分层的多变量 CSM 分析中，ILND 与 N1（HR：0.25；P<0.001）和 N2-3（HR：0.42；P=0.01）患者的 CSM 降低相关，但与 N0 患者无关。在 NIS 数据库中，淋巴结侵犯（LNI）的存在与住院时间延长相关（优势比：1.27，P=0.01），但与更高的并发症发生率或院内死亡率无关。
ILND 的指南遵循率较低（24.7%），且随时间变化没有改变。尽管如此，在 N1、N2 和 N3 患者中，ILND 与 CSM 获益相关。并发症发生率和院内死亡率与 LNI 无关。然而，LNI 患者的住院时间可能更长。最后，应该注意的是，临床和病理 N 分期之间没有区别是一个重要的局限性。
