H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
Department of Medical Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
J Urol. 2023 Mar;209(3):557-564. doi: 10.1097/JU.0000000000003099. Epub 2023 Jan 18.
Inguinal lymph node dissection within 3 months of primary tumor resection in penile cancer has been associated with longer recurrence-free and cancer-specific survival. However, the optimal timing and effect of lymphadenectomy performed concurrently at the time of primary lesion management on oncologic outcomes in clinically lymph node positive penile squamous cell carcinoma remains unknown.
An international, multicenter cohort of 966 penile cancer cases was queried for penile squamous cell carcinoma management after the year 2000, clinically lymph node positive status, and performance of penile surgery and inguinal lymph node dissection. Cohorts were stratified as concomitant if inguinal lymph node dissection and penile surgery occurred on the same date or staged when inguinal lymph node dissection was performed after penile resection. Rates and patterns of penile squamous cell carcinoma recurrence were reported. Distant recurrence-free, cancer-specific, and overall survival were estimated using Kaplan-Meier analyses and groups compared with log-rank testing.
Of 253 contemporary men with clinically lymph node positive penile squamous cell carcinoma, 96 (38%) underwent concomitant inguinal lymph node dissection and 157 (62%) had inguinal lymph node dissection performed in a staged manner. Penile cancer was most likely to recur distantly (19%) followed by in the groin (14%) or pelvis (5%). There were no differences in distant recurrence-free, cancer-specific, or overall survival between management strategies. Multivariable analysis adjusting for stage, treatment center, and perioperative chemoradiation also demonstrated no recurrence-free, cancer-specific, or overall survival benefit between management strategies.
Inguinal lymph node dissection performed concurrently with excision of the penile tumor for clinically node positive penile squamous cell carcinoma is not associated with differences in recurrence-free, cancer-specific, or overall survival compared to staged lymph node dissection.
在阴茎癌原发肿瘤切除后 3 个月内行腹股沟淋巴结清扫术与无复发生存和癌症特异性生存时间延长相关。然而，在临床淋巴结阳性的阴茎鳞癌中，同期行原发性病变处理时行淋巴结切除术对肿瘤学结果的最佳时机和效果尚不清楚。
在 2000 年后，对国际多中心队列的 966 例阴茎癌病例进行了阴茎鳞癌治疗、临床淋巴结阳性状态以及阴茎手术和腹股沟淋巴结清扫术的查询。如果腹股沟淋巴结清扫术和阴茎手术在同一天进行，则将队列分层为同期；如果腹股沟淋巴结清扫术在阴茎切除后进行，则将队列分层为分期。报告了阴茎鳞癌复发的率和模式。使用 Kaplan-Meier 分析估计远处无复发生存、癌症特异性和总体生存率，并使用对数秩检验比较组间差异。
在 253 例临床淋巴结阳性的阴茎鳞癌患者中，96 例（38%）行同期腹股沟淋巴结清扫术，157 例（62%）行分期腹股沟淋巴结清扫术。阴茎癌最有可能远处复发（19%），其次是腹股沟（14%）或骨盆（5%）。在管理策略之间，远处无复发生存、癌症特异性或总体生存率没有差异。多变量分析调整了分期、治疗中心和围手术期放化疗，也表明在管理策略之间无复发生存、癌症特异性或总体生存率没有获益。
对于临床淋巴结阳性的阴茎鳞癌，同期行腹股沟淋巴结清扫术与切除阴茎肿瘤相比，无复发生存、癌症特异性或总体生存率没有差异。
