Sachdeva Ashwin, McGuinness Luke, Zapala Łukasz, Greco Isabella, Garcia-Perdomo Herney Andres, Kailavasan Mithun, Antunes-Lopes Tiago, Ayres Benjamin, Barreto Lenka, Campi Riccardo, Crook Juanita, Johnstone Peter, Kumar Vivek, Manzie Kenneth, Marcus Jack David, Necchi Andrea, Oliveira Pedro, Osborne John, Pagliaro Lance C, Protzel Chris, Bryan Rumble R, Sánchez Martínez Diego F, Spiess Philippe E, Tagawa Scott T, van der Heijden Michiel S, Parnham Arie S, Pettaway Curtis A, Albersen Maarten, Sangar Vijay K, Brouwer Oscar R, Sakalis Vasileios I
Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Urology, The Christie NHS Foundation Trust, Manchester, UK.
Department of Urology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK.
Eur Urol. 2024 Mar;85(3):257-273. doi: 10.1016/j.eururo.2023.04.018. Epub 2023 May 18.
Lymph node (LN) involvement in penile cancer is associated with poor survival. Early diagnosis and management significantly impact survival, with multimodal treatment approaches often considered in advanced disease.
To assess the clinical effectiveness of treatment options available for the management of inguinal and pelvic lymphadenopathy in men with penile cancer.
EMBASE, MEDLINE, the Cochrane Database of Systematic Reviews, and other databases were searched from 1990 to July 2022. Randomised controlled trials (RCTs), nonrandomised comparative studies (NRCSs), and case series (CSs) were included.
We identified 107 studies, involving 9582 patients from two RCTs, 28 NRCSs, and 77 CSs. The quality of evidence is considered poor. Surgery is the mainstay of LN disease management, with early inguinal LN dissection (ILND) associated with better outcomes. Videoendoscopic ILND may offer comparable survival outcomes to open ILND with lower wound-related morbidity. Ipsilateral pelvic LN dissection (PLND) in N2-3 cases improves overall survival in comparison to no pelvic surgery. Neoadjuvant chemotherapy in N2-3 disease showed a pathological complete response rate of 13% and an objective response rate of 51%. Adjuvant radiotherapy may benefit pN2-3 but not pN1 disease. Adjuvant chemoradiotherapy may provide a small survival benefit in N3 disease. Adjuvant radiotherapy and chemotherapy improve outcomes after PLND for pelvic LN metastases.
Early LND improves survival in nodal disease in penile cancer. Multimodal treatments may provide additional benefit in pN2-3 cases; however, data are limited. Therefore, individualised management of patients with nodal disease should be discussed in a multidisciplinary team setting.
Spread of penile cancer to the lymph nodes is best managed with surgery, which improves survival and has curative potential. Supplementary treatment, including the use of chemotherapy and/or radiotherapy, may further improve survival in advanced disease. Patients with penile cancer with lymph node involvement should be treated by a multidisciplinary team.
阴茎癌出现淋巴结（LN）转移与生存率低相关。早期诊断和治疗对生存率有显著影响，晚期疾病通常考虑采用多模式治疗方法。
评估阴茎癌男性患者腹股沟和盆腔淋巴结病现有治疗方案的临床疗效。
检索了1990年至2022年7月的EMBASE、MEDLINE、Cochrane系统评价数据库及其他数据库。纳入随机对照试验（RCT）、非随机对照研究（NRCS）和病例系列（CS）。
我们识别出107项研究，涉及来自2项RCT、28项NRCS和77项CS的9582例患者。证据质量被认为较低。手术是淋巴结疾病治疗的主要方法，早期腹股沟淋巴结清扫术（ILND）与更好的预后相关。视频内镜ILND与开放ILND相比，可能具有相当的生存结局且伤口相关发病率更低。N2 - 3期病例行同侧盆腔淋巴结清扫术（PLND）与不行盆腔手术相比可提高总生存率。N2 - 3期疾病新辅助化疗的病理完全缓解率为13%，客观缓解率为51%。辅助放疗可能对pN2 - 3期疾病有益，但对pN1期疾病无益。辅助放化疗可能对N3期疾病有小的生存获益。辅助放疗和化疗可改善PLND治疗盆腔淋巴结转移后的结局。
早期淋巴结清扫术可提高阴茎癌淋巴结转移疾病的生存率。多模式治疗可能在pN2 - 3期病例中提供额外获益；然而，数据有限。因此，应在多学科团队环境中讨论淋巴结疾病患者的个体化管理。
阴茎癌转移至淋巴结最好通过手术治疗，手术可提高生存率并有治愈潜力。包括化疗和/或放疗在内的辅助治疗可能进一步提高晚期疾病的生存率。阴茎癌伴淋巴结转移的患者应由多学科团队治疗。
