临床 N1 期阴茎鳞癌行双侧腹股沟淋巴结清扫术与单侧腹股沟淋巴结清扫术联合动态前哨淋巴结活检术的比较

Bilateral inguinal lymph-node dissection vs. unilateral inguinal lymph-node dissection and dynamic sentinel node biopsy in clinical N1 squamous cell carcinoma of the penis.

机构信息

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.

出版信息

Urol Oncol. 2023 Apr;41(4):210.e1-210.e8. doi: 10.1016/j.urolonc.2023.02.001. Epub 2023 Mar 1.

DOI:10.1016/j.urolonc.2023.02.001

PMID:36868883

Abstract

INTRODUCTION

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.

MATERIAL AND METHODS

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).

RESULTS

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).

CONCLUSIONS

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.

摘要

介绍

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。

材料和方法

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。

结果

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）。