Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
Urology. 2021 Jul;153:221-227. doi: 10.1016/j.urology.2021.02.019. Epub 2021 Feb 24.
To (1) examine the contemporary incidence of occult inguinal LN metastases and (2) identify predictors of occult inguinal LN metastases to improve selection of cN0 patients for inguinal lymphadenectomy (ILND).
We identified 590 men with cTany cN0 cM0 penile cancer who underwent partial/radical penectomy and ILND from 2006-2016 in the NCDB. Rates of pN+ disease were examined, and a multivariable regression model was constructed to identify features associated with pN+ disease.
Tumors were ≤pT1 in 21%, pT2 in 43%, and pT3/pT4 in 24% of patients. A median of 15 (IQR 8-22) LNs were removed at ILND. The overall pN+ rate was 24% and did not vary over the study period. The pN+ rate, stratified by pT stage, varied from 18-33%. On multivariable analysis, only higher tumor grade (OR 2.16; P = 0.02 for grade 2; OR 2.81; P = 0.005 for grade 3-4, versus grade 1) and lymphovascular invasion (OR 3.12; P <0.001) were independently associated with pN+ disease, whereas pT stage was not.
The contemporary rate of occult LN metastases in men with cN0 penile cancer remains high at approximately 24%. Our results suggest that high tumor grade and/or lymphovascular invasion are better determinants of lymph node involvement than primary tumor stage.
（1）研究隐匿性腹股沟淋巴结转移的当代发生率，（2）确定隐匿性腹股沟淋巴结转移的预测因子，以改善 cN0 患者行腹股沟淋巴结清扫术（ILND）的选择。
我们在 NCDB 中识别了 590 名接受部分/根治性阴茎切除术和 ILND 的 cTany cN0 cM0 阴茎癌男性患者，这些患者均来自 2006 年至 2016 年。我们检查了 pN+疾病的发生率，并构建了多变量回归模型来识别与 pN+疾病相关的特征。
肿瘤 pT1 期患者占 21%，pT2 期患者占 43%，pT3/pT4 期患者占 24%。ILND 时中位数切除 15 个（IQR 8-22）个淋巴结。总体 pN+率为 24%，且在研究期间没有变化。根据 pT 分期分层，pN+率从 18%到 33%不等。多变量分析显示，仅肿瘤分级较高（OR 2.16；P=0.02 对于 2 级；OR 2.81；P=0.005 对于 3-4 级，与 1 级相比）和淋巴管侵犯（OR 3.12；P<0.001）与 pN+疾病独立相关，而 pT 分期则不然。
cN0 阴茎癌男性隐匿性淋巴结转移的当代发生率仍高达约 24%。我们的结果表明，高肿瘤分级和/或淋巴管侵犯是淋巴结受累的更好预测因子，而不是原发肿瘤分期。
