阴茎保留手术治疗阴茎浅表或初始侵袭性鳞状细胞癌患者：长期肿瘤学结果。
Penile-sparing surgery for patients with superficial or initially invasive squamous cell carcinoma of the penis: long-term oncological outcomes.
机构信息
Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Milan, Italy.
Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Università degli Studi di Milano, Milan, Italy.
出版信息
Urol Oncol. 2021 Oct;39(10):736.e1-736.e7. doi: 10.1016/j.urolonc.2021.06.020. Epub 2021 Jul 21.
PURPOSE
To report long-term oncological outcomes after penile-sparing surgery (PSS) for superficial (Ta-Tis) or initially invasive (T1) penile cancer patients.
METHODS
We retrospectively analysed 85 patients with Ta/Tis/T1cN0cM0 penile cancer (1996-2018). All patients underwent PSS: circumcision, excision or laser ablation. First, Kaplan-Meier plots and multivariable Cox regression models tested tumor recurrence rates (any local/regional/metastatic). Second, Kaplan-Meier plots depicted progression-free survival (≥T2 or N1-3 or M1 disease).
RESULTS
Median (IQR) follow-up time was 64 (48-95) months. Overall, 48 (56%) patients experienced tumor recurrence. Median (IQR) time to tumor recurrence was 34 (7-52) months. Higher recurrence rates were observed for Tis (65%) and T1 (64%), compared to Ta (40%), but these differences were not significant on multivariable Cox regression analyses (HR:2.0 with 95% CI [0.9-5.1] and HR:2.2 with 95% CI [0.9-5.9], respectively). Moreover, higher recurrence rates were observed for G2-3 tumors (74%), compared to G1 (57%), but these differences were not significant on multivariable Cox regression analyses (HR:1.6; 95% CI [0.8-3.2]). During follow-up, 15 (17.5%) vs. 18 (21.2%) vs. 10 (11.5%) patients underwent 1 vs. 2 vs. ≥3 PSS. Moreover, 26 (30.6%) and 4 (4.7%) men were treated with glansectomy and partial/total penile amputation due to local progression, tumor size or patient preference. Additionally, 24 (28%) men underwent invasive nodal staging. Last, 22 (25.9%) patients experienced disease progression. Median (IQR) time to disease progression was 51 (31-82) months.
CONCLUSION
Patients treated with PSS for newly diagnosed superficial or initially invasive squamous cell carcinoma of the penis should be informed about the non-negligible risk of tumor recurrence and disease progression over time. In consequence, strict follow-up protocols are needed.
目的
报告阴茎保留手术（PSS）治疗浅表（Ta-Tis）或初始浸润（T1）阴茎癌患者的长期肿瘤学结果。
方法
我们回顾性分析了 85 例 Ta/Tis/T1cN0cM0 阴茎癌患者（1996-2018 年）。所有患者均接受了 PSS：包皮环切术、切除术或激光消融术。首先，使用 Kaplan-Meier 图和多变量 Cox 回归模型检测肿瘤复发率（任何局部/区域/远处转移）。其次，Kaplan-Meier 图描绘了无进展生存率（≥T2 或 N1-3 或 M1 疾病）。
结果
中位（IQR）随访时间为 64（48-95）个月。85 例患者中，48 例（56%）患者出现肿瘤复发。肿瘤复发的中位（IQR）时间为 34（7-52）个月。Tis（65%）和 T1（64%）的复发率高于 Ta（40%），但多变量 Cox 回归分析显示这些差异无统计学意义（HR：2.0，95%CI [0.9-5.1] 和 HR：2.2，95%CI [0.9-5.9]）。此外，G2-3 肿瘤（74%）的复发率高于 G1（57%），但多变量 Cox 回归分析显示这些差异无统计学意义（HR：1.6；95%CI [0.8-3.2]）。在随访期间，15 例（17.5%）、18 例（21.2%）和 10 例（11.5%）患者分别接受了 1 次、2 次和≥3 次 PSS。此外，26 例（30.6%）和 4 例（4.7%）男性因局部进展、肿瘤大小或患者意愿而行阴茎部分/全部切除术和阴茎头切除术。此外，24 例（28%）男性行淋巴结侵袭性分期。最后，22 例（25.9%）患者发生疾病进展。疾病进展的中位（IQR）时间为 51（31-82）个月。
结论
对于新诊断的浅表或初始浸润性阴茎鳞状细胞癌患者，接受 PSS 治疗的患者应了解肿瘤复发和疾病进展的风险不容忽视。因此，需要严格的随访方案。
Zotero 插件