Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Università degli Studi di Milano, Italy.
Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
Urol Oncol. 2023 Apr;41(4):210.e1-210.e8. doi: 10.1016/j.urolonc.2023.02.001. Epub 2023 Mar 1.
To evaluate the role of unilateral inguinal lymph-node dissection (ILND) plus contralateral dynamic sentinel node biopsy (DSNB) vs. bilateral ILND in clinical N1 (cN1) penile squamous cell carcinoma (peSCC) patients.
Within our institutional database (1980-2020, included), we identified 61 consecutive cT1-4 cN1 cM0 patients with histological confirmed peSCC who underwent either unilateral ILND plus DSNB (26) or bilateral ILND (35).
Median age was 54 years (Interquartile range [IQR]: 48-60 years). Median follow-up was 68 months (IQR 21-105 months). Most patients had pT1 (23 %) or pT2 (54.1%), as well as G2 (47.5%) or G3 (23%) tumors, while lymphovascular invasion (LVI) was present in 67.1% of cases. Considering a cN1 and a cN0 groin, overall 57 out of 61 patients (93.5%) had nodal disease in the cN1 groin. Conversely, only 14 out of 61 patients (22.9%) had nodal disease in the cN0 groin. 5-year IR-free survival was 91% (Confidence interval [CI] 80%-100%) for bilateral ILND group and 88% (CI 73%-100%) for the ipsilateral ILND plus DSNB group (P-value 0.8). Conversely, 5-year CSS was 76% (CI 62%-92%) for bilateral ILND group and 78% (CI 63%-97%) for the ipsilateral ILND plus contralateral DSNB group (P-value 0.9).
In patients with cN1 peSCC the risk of occult contralateral nodal disease is comparable to cN0 high risk peSCC and the gold standard, namely bilateral ILND, may be replaced by unilateral ILND and contralateral DSNB without affecting positive node detection, IRRs and CSS.
评估单侧腹股沟淋巴结清扫术（ILND）加对侧动态前哨淋巴结活检（DSNB）与双侧 ILND 在临床 N1（cN1）阴茎鳞状细胞癌（peSCC）患者中的作用。
在我们的机构数据库中（1980-2020 年，包括），我们确定了 61 例连续接受组织学证实的 peSCC 且接受单侧 ILND 加 DSNB（26 例）或双侧 ILND（35 例）治疗的 cT1-4 cN1 cM0 患者。
中位年龄为 54 岁（四分位距 [IQR]：48-60 岁）。中位随访时间为 68 个月（IQR 21-105 个月）。大多数患者为 pT1（23%）或 pT2（54.1%），G2（47.5%）或 G3（23%）肿瘤，而 67.1%的病例存在淋巴血管侵犯（LVI）。考虑到 cN1 和 cN0 腹股沟，共有 61 例患者中的 57 例（93.5%）在 cN1 腹股沟有淋巴结疾病。相反，只有 61 例患者中的 14 例（22.9%）在 cN0 腹股沟有淋巴结疾病。双侧 ILND 组的 5 年无复发生存率为 91%（置信区间 [CI] 80%-100%），同侧 ILND 加 DSNB 组为 88%（CI 73%-100%）（P 值 0.8）。相反，双侧 ILND 组的 5 年 CSS 为 76%（CI 62%-92%），同侧 ILND 加对侧 DSNB 组为 78%（CI 63%-97%）（P 值 0.9）。
在 cN1 peSCC 患者中，隐匿性对侧淋巴结疾病的风险与 cN0 高危 peSCC 相当，金标准即双侧 ILND 可被同侧 ILND 加对侧 DSNB 取代，而不会影响阳性淋巴结的检出率、IRR 和 CSS。
