Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
J Urol. 2021 Aug;206(2):354-363. doi: 10.1097/JU.0000000000001775. Epub 2021 Apr 12.
We evaluated the oncologic efficacy of early inguinal lymph-node dissection, observation or dynamic sentinel node biopsy followed by delayed or selective inguinal lymph-node dissection in cN0 patients with penile squamous cell carcinoma.
Between 1980 and 2017 (inclusive), 296 evaluable consecutive cN0 penile squamous cell carcinoma patients underwent early inguinal lymph-node dissection (16), observation (114) or dynamic sentinel node biopsy (166). Median followup was 50 months. Tumor stage, grade, lympho-vascular invasion and age were considered. Kaplan-Meier plots illustrated 5-year inguinal relapse-free and cancer specific survival rates. Multivariable Cox regression models tested the treatment effect. Analyses were repeated after inverse probability of treatment weighting adjustment.
The 5-year inguinal relapse-free survival and cancer specific survival rates following early, observation and dynamic sentinel node biopsy inguinal lymph-node dissection were 100%, 87%, 89%, and 84%, 81%, 85%, respectively. The 5-year crude inguinal relapse-free survival and cancer specific survival rates were 90% and 93% in low-risk patients undergoing observation. Clavien grade 3 complications were 0.6 vs 12.5% in the dynamic sentinel node biopsy and early inguinal lymph-node dissection group, respectively. After inverse probability after treatment weighting adjustment, 5-year inguinal relapse and cancer specific survival were 90% vs 73% and 90% vs 77% following dynamic sentinel node biopsy and observation, respectively. At multivariable Cox regression model, patients undergoing dynamic sentinel node biopsy had significantly lower inguinal relapse (HR 0.4, 95% CI 0.2-0.85, p 0.02) and cancer specific mortality (HR 0.29, 95% CI 0.11-0.77; p=0.01) compared to those under observation. The low number of patients undergoing early inguinal lymph-node dissection made a reliable comparison with this group impractical.
Selective inguinal lymph-node dissection following dynamic sentinel node biopsy significantly improved inguinal relapse and cancer specific mortality when compared with observation, providing evidence of efficacy of dynamic sentinel node biopsy in clinical stage N0 squamous cell carcinoma of the penis.
我们评估了早期腹股沟淋巴结清扫术、观察或动态前哨淋巴结活检后延迟或选择性腹股沟淋巴结清扫术在 cN0 阴茎鳞癌患者中的肿瘤学疗效。
1980 年至 2017 年（包括）期间，296 例可评估的连续 cN0 阴茎鳞癌患者接受了早期腹股沟淋巴结清扫术（16 例）、观察（114 例）或动态前哨淋巴结活检（166 例）。中位随访时间为 50 个月。考虑了肿瘤分期、分级、淋巴血管侵犯和年龄。Kaplan-Meier 图显示了 5 年腹股沟无复发生存率和癌症特异性生存率。多变量 Cox 回归模型测试了治疗效果。在进行逆概率治疗加权调整后，对分析结果进行了重复。
早期、观察和动态前哨淋巴结活检腹股沟淋巴结清扫术后 5 年腹股沟无复发生存率和癌症特异性生存率分别为 100%、87%、89%和 84%、81%、85%。观察中低危患者的 5 年粗腹股沟无复发生存率和癌症特异性生存率分别为 90%和 93%。动态前哨淋巴结活检和早期腹股沟淋巴结清扫组的 Clavien 3 级并发症分别为 0.6%和 12.5%。在进行逆概率治疗加权调整后，动态前哨淋巴结活检和观察后的 5 年腹股沟复发和癌症特异性生存率分别为 90% vs 73%和 90% vs 77%。多变量 Cox 回归模型显示，与观察组相比，行动态前哨淋巴结活检的患者腹股沟复发率显著降低（HR 0.4，95%CI 0.2-0.85，p=0.02）和癌症特异性死亡率（HR 0.29，95%CI 0.11-0.77；p=0.01）。早期腹股沟淋巴结清扫术患者数量较少，与该组进行可靠比较不太实际。
与观察相比，动态前哨淋巴结活检后选择性腹股沟淋巴结清扫术显著降低了腹股沟复发率和癌症特异性死亡率，为动态前哨淋巴结活检在临床 N0 期阴茎鳞癌中的疗效提供了证据。
