Department of Urology, West Virginia University, Morgantown, WV, USA.
Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
Int Braz J Urol. 2021 Sep-Oct;47(5):943-956. doi: 10.1590/S1677-5538.IBJU.2020.0959.
Squamous cell carcinoma (SCC) of the penis is a rare disease in developed countries but is associated with significant morbidity and mortality. A crucial prognostic factor is the presence of inguinal lymph node metastases (ILNM) at the time of diagnosis. At least 25% of cases have micrometastases at the time of diagnosis. Therefore, we performed a literature review of studies evaluating factors, both clinical and pathological, predictive of lymph node metastases in penile SCC.
Studies were identified using PubMed and search terms included the following: penile cancer, penile tumor, penile neoplasm, penile squamous cell carcinoma, inguinal lymph node metastasis, lymph node metastases, nodal metastasis, inguinal node metastasis, inguinal lymph node involvement, predictors, and predictive factor. The number of patients and predictive factors were identified for each study based on OR, HR, or RR in multivariate analyses, as well as their respective significance values. These were compiled to generate a single body of evidence supportive of factors predictive of ILNM in penile SCC.
We identified 31 studies, both original articles and meta-analyses, which identified factors predictive of metastases in penile SCC. The following clinical factors were predictive of ILNM in penile SCC: lymphovascular invasion (LVI), increased grade, increased stage (both clinical and pathological), infiltrative and reticular invasion, increased depth of invasion, perineural invasion, and younger patient age at diagnosis. Biochemically, overexpression of p53, SOD2, Ki-67, and ID1 were associated with spread of SCC to inguinal lymph nodes. Diffuse PD-L1 expression, increased SCC-Ag expression, increased NLR, and CRP >20 were also associated with increased ILNM.
A multitude of factors are associated with metastasis of SCC of the penis to inguinal lymph nodes, which is associated with poor clinical outcomes. The above factors, most strongly LVI, grade, and node positivity, may be considered when constructing a nomogram to risk-stratify patients and determine eligibility for prophylactic inguinal lymphadenectomy.
在发达国家，阴茎鳞状细胞癌（SCC）较为罕见，但与较高的发病率和死亡率相关。一个关键的预后因素是在诊断时是否存在腹股沟淋巴结转移（ILNM）。至少 25%的病例在诊断时存在微转移。因此，我们对评估阴茎 SCC 淋巴结转移相关的临床和病理因素的研究进行了文献回顾。
使用 PubMed 进行研究检索，检索词包括：阴茎癌、阴茎肿瘤、阴茎肿瘤、阴茎鳞状细胞癌、腹股沟淋巴结转移、淋巴结转移、淋巴结转移、腹股沟淋巴结转移、腹股沟淋巴结受累、预测因子和预测因素。根据多变量分析中的 OR、HR 或 RR 以及各自的显著性值，确定每项研究的患者数量和预测因素。将这些数据汇总生成支持阴茎 SCC 中 ILNM 预测因素的单一证据体。
我们共确定了 31 项研究，包括原始文章和荟萃分析，这些研究确定了预测阴茎 SCC 转移的因素。以下临床因素与阴茎 SCC 的 ILNM 相关：淋巴血管侵犯（LVI）、分级升高、分期升高（临床和病理）、浸润性和网状侵犯、浸润深度增加、神经周围侵犯以及诊断时较年轻的患者年龄。在生化方面，p53、SOD2、Ki-67 和 ID1 的过度表达与 SCC 扩散至腹股沟淋巴结相关。弥漫性 PD-L1 表达、SCC-Ag 表达增加、NLR 增加和 CRP>20 也与增加的 ILNM 相关。
多种因素与 SCC 阴茎转移至腹股沟淋巴结相关，这与较差的临床结局相关。上述因素，尤其是 LVI、分级和淋巴结阳性，在构建风险分层患者和确定预防性腹股沟淋巴结清扫术的适应证的列线图时可加以考虑。
