Ma Shanjin, Zhao Jian, Liu Zhiwei, Wu Tao, Wang Sheng, Wu Chengwen, Pan Lei, Jiang Xiaoye, Guan Zhihao, Wang Yanjun, Jiao Dian, Yan Fengqi, Zhang Keying, Tang Qisheng, Ma Jianjun
Department of Urology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
Department of Urology, The 955th Hospital of Army, Changdu, China.
Front Oncol. 2023 Feb 21;13:1069284. doi: 10.3389/fonc.2023.1069284. eCollection 2023.
Few reports have investigated the oncologically safe timing of prophylactic inguinal lymphadenectomy for penile cancer patients with clinically normal inguinal lymph nodes (cN0), particularly those who received delayed surgical treatment.
The study included pT1aG2, pT1b-3G1-3 cN0M0 patients with penile cancer who received prophylactic bilateral inguinal lymph nodes dissection (ILND) at the Department of Urology of Tangdu Hospital between October 2002 and August 2019. Patients who received simultaneous resection of primary tumor and inguinal lymph nodes were assigned to the immediate group, while the rest were assigned to the delayed group. The optimal timing of lymphadenectomy was determined based on the time-dependent ROC curves. The disease-specific survival (DSS) was estimated based on the Kaplan-Meier curve. Cox regression analysis was used to evaluate the associations between DSS and the timing of lymphadenectomy and tumor characteristics. The analyses were repeated after stabilized inverse probability of treatment weighting adjustment.
A total of 87 patients were enrolled in the study, 35 of them in the immediate group and 52 in the delayed group. The median (range) interval time between primary tumor resection and ILND of the delayed group was 85 (29-225) days. Multivariable Cox analysis demonstrated that immediate lymphadenectomy was associated with a significant survival benefit (HR, 0.11; 95% CI, 0.02-0.57; = 0.009). An index of 3.5 months was determined as the optimal cut-point for dichotomization in the delayed group. In high-risk patients who received delayed surgical treatment, prophylactic inguinal lymphadenectomy within 3.5 months was associated with a significantly better DSS compared to dissection after 3.5months (77.8% and 0%, respectively; log-rank <0.001).
Immediate and prophylactic inguinal lymphadenectomy in high-risk cN0 patients (pT1bG3 and all higher stage tumours) with penile cancer improves survival. For those patients at high risk who received delayed surgical treatment for any reason, within 3.5 months after resection of the primary tumor seems to be an oncologically safe window for prophylactic inguinal lymphadenectomy.
对于腹股沟淋巴结临床正常（cN0）的阴茎癌患者，尤其是那些接受延迟手术治疗的患者，很少有报告研究预防性腹股沟淋巴结清扫术在肿瘤学上的安全时机。
该研究纳入了2002年10月至2019年8月期间在唐都医院泌尿外科接受预防性双侧腹股沟淋巴结清扫术（ILND）的pT1aG2、pT1b - 3G1 - 3 cN0M0阴茎癌患者。同时切除原发肿瘤和腹股沟淋巴结的患者被分配到即刻组，其余患者被分配到延迟组。基于时间依赖性ROC曲线确定淋巴结清扫的最佳时机。基于Kaplan - Meier曲线估计疾病特异性生存率（DSS）。使用Cox回归分析评估DSS与淋巴结清扫时机和肿瘤特征之间的关联。在稳定的逆概率治疗权重调整后重复分析。
共87例患者纳入研究，其中即刻组35例，延迟组52例。延迟组原发肿瘤切除与ILND之间的中位（范围）间隔时间为85（29 - 225）天。多变量Cox分析表明，即刻淋巴结清扫与显著的生存获益相关（HR，0.11；95%CI，0.02 - 0.57；P = 0.009）。确定3.5个月为延迟组二分法的最佳切点。在接受延迟手术治疗的高危患者中，与3.5个月后清扫相比，3.5个月内进行预防性腹股沟淋巴结清扫术的DSS显著更好（分别为77.8%和0%；对数秩检验<0.001）。
对于高危cN0（pT1bG3及所有更高分期肿瘤）阴茎癌患者，即刻进行预防性腹股沟淋巴结清扫术可提高生存率。对于因任何原因接受延迟手术治疗的高危患者，在原发肿瘤切除后3.5个月内似乎是预防性腹股沟淋巴结清扫术在肿瘤学上的安全窗口。
