Bowie Jessica, Singh Sobha, O'Hanlon Ciaran, Shiatis Vishal, Brunckhorst Oliver, Muneer Asif, Ahmed Kamran
Guy's Campus, King's College London School of Bioscience Education, London, UK.
MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK.
Turk J Urol. 2021 Sep;47(5):358-365. doi: 10.5152/tud.2021.21199.
The presence of lymph node metastasis is the most important prognostic indicator for patients with penile cancer. However, predicting which clinically node negative patients will harbor lymph node metastases remains unclear. The aim of this systematic review is to provide an overview of biomarkers p53, Ki-67, and SCCAg in predicting lymph node metastasis (LNM) and cancer-specific survival (CSS) in penile squamous cell carcinoma (SCC). MEDLINE, EMBASE, Cochrane Library, Scopus, and ClinicalTrials.gov were searched from inception until 15 October 2020. Eligible studies were identified by three independent reviewers. Outcome measures included the presence of penile LNM and CSS. Extracted data were narratively synthesized with GRADE criteria utilized to evaluate the quality of evidence. In total, 999 articles were screened with 20 selected for inclusion. Studies reporting the use of p53 to predict LNM and CSS were rated as having the highest quality of evidence using the GRADE criteria, and the majority showed a positive association between p53 expression and LNM and CSS. All biomarkers and outcome combinations had at least one study showing a significant effect on predicting the outcome. However, studies were heterogeneous, and many reported nonsignificant effects. Identifying p53 overexpression may help one to identify patients at higher risks of LNM to be considered for early inguinal lymphadenectomy. There is contradictory and unreliable evidence for the prognostic value of Ki-67 and SCCAg in penile SCC for LNM and CSS. Larger studies are required with more rigorous methods and reports to improve the evidence base.
淋巴结转移的存在是阴茎癌患者最重要的预后指标。然而，预测哪些临床淋巴结阴性患者会发生淋巴结转移仍不明确。本系统评价的目的是概述生物标志物p53、Ki-67和鳞状细胞癌抗原（SCCAg）在预测阴茎鳞状细胞癌（SCC）淋巴结转移（LNM）和癌症特异性生存（CSS）方面的作用。检索了MEDLINE、EMBASE、Cochrane图书馆、Scopus和ClinicalTrials.gov，检索时间从数据库建立至2020年10月15日。由三名独立 reviewers 确定符合条件的研究。结局指标包括阴茎LNM的存在和CSS。提取的数据采用GRADE标准进行叙述性综合，以评估证据质量。共筛选了999篇文章，其中20篇被选定纳入。使用GRADE标准，报告使用p53预测LNM和CSS的研究被评为证据质量最高，大多数研究表明p53表达与LNM和CSS之间存在正相关。所有生物标志物和结局组合至少有一项研究显示对预测结局有显著影响。然而，研究具有异质性，许多研究报告的影响不显著。识别p53过表达可能有助于识别LNM风险较高的患者，以便考虑早期腹股沟淋巴结清扫术。关于Ki-67和SCCAg在阴茎SCC中对LNM和CSS的预后价值，存在相互矛盾且不可靠的证据。需要采用更严格的方法和报告进行更大规模的研究，以改善证据基础。
