Key Laboratory of Oncology in Southern China, Guangzhou, China.
Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China.
J Urol. 2021 Jan;205(1):145-151. doi: 10.1097/JU.0000000000001322. Epub 2020 Aug 5.
A map of pelvic lymph node metastasis in patients with penile cancer helps to clarify the pattern of pelvic spread and define the reasonable limits of dissection, and it has not been established. We aim to provide an accurate map of lymph node metastasis in patients with penile cancer and determine the reasonable extent of pelvic lymph node dissection.
We enrolled patients with penile cancer undergoing pelvic lymph node dissection (128) at our institution from 1999 to 2018. The numbers of removed lymph nodes and positive lymph nodes at 10 distinct regions were recorded. The chi-square and Fisher exact tests were used.
The median number of pelvic lymph nodes retrieved was 18 (IQR 10-30), with the majority being from the external iliac package (43.0%) and obturator package (31.9%). Pelvic lymph node metastasis was present in 57/128 (44.5%) patients. The median number of positive pelvic lymph nodes removed was 2 (IQR 1-4), with the majority being from the external iliac package (50.0%) and obturator package (36.6%). Advanced T-stage was related to higher risk of pelvic lymph node metastasis, which was present in 30.3%, 44.2%, 59.0% and 58.3% of patients with pT1, pT2, pT3 and pT4, respectively. Notably, 2 patients had crossover metastasis from 1 inguinal region to the contralateral pelvic region.
We present a detailed map of pelvic lymph node metastasis in patients with penile carcinoma. The external iliac and obturator packages appear to be most commonly involved. Optimal pelvic lymph node dissection may extend to the common iliac artery, including common iliac, external iliac, internal iliac and obturator lymph nodes. Extranodal extension in inguinal nodes may not be as important as previously thought.
阴茎癌患者的盆腔淋巴结转移图谱有助于阐明盆腔扩散模式并确定合理的解剖范围，但尚未建立。我们旨在为阴茎癌患者提供准确的淋巴结转移图谱，并确定合理的盆腔淋巴结清扫范围。
我们回顾性分析了 1999 年至 2018 年在我院行盆腔淋巴结清扫术（128 例）的阴茎癌患者的临床资料。记录了 10 个不同区域的淋巴结清扫数量和阳性淋巴结数量。采用卡方检验和 Fisher 确切概率法进行统计学分析。
盆腔淋巴结清除的中位数为 18（IQR 10-30），其中大部分来自髂外组（43.0%）和闭孔组（31.9%）。128 例患者中有 57 例（44.5%）存在盆腔淋巴结转移。阳性淋巴结清除的中位数为 2（IQR 1-4），其中大部分来自髂外组（50.0%）和闭孔组（36.6%）。较高的 T 分期与较高的盆腔淋巴结转移风险相关，pT1、pT2、pT3 和 pT4 患者的盆腔淋巴结转移率分别为 30.3%、44.2%、59.0%和 58.3%。值得注意的是，2 例患者的腹股沟区淋巴结发生交叉转移至对侧盆腔区域。
我们提出了阴茎癌患者盆腔淋巴结转移的详细图谱。髂外组和闭孔组似乎是最常受累的部位。优化的盆腔淋巴结清扫术可能扩展至髂总动脉，包括髂总、髂外、髂内和闭孔淋巴结。腹股沟淋巴结的结外侵犯可能没有以前认为的那么重要。
