Department of Urology, Norfolk and Norwich University Hospitals NHS Trust, Norwich, NR4 7UY, UK.
BMC Urol. 2023 Aug 15;23(1):137. doi: 10.1186/s12894-023-01303-9.
Lymph node metastasis is the main determinant of survival in penile cancer patients. Conventionally clinical palpability is used to stratify patients to Inguinal Lymph node dissection (ILND) if clinically node positive (cN +) or Dynamic sentinel node biopsy (DSNB) if clinically node negative (cN0). Studies suggest a false negative rate (FNR) of around 10% (5-13%) for DSNB. To our knowledge there are no studies reporting harder end point of survival and outcomes of all clinically node positive (cN +) patients. We present our outcome data of all patients with penile cancer including false negative rates and survival in both DSNB and ILND groups.
One hundred fifty-eight consecutive patients (316 inguinal basins), who had lymph node surgery for penile cancer in a tertiary referral centre from Jan 2008 to 2018, were included in the study. All patients underwent ultrasound (US) ± fine needle aspiration cytology (FNAC) and then MRI/ CT, if needed, to stage their disease. We used combined clinical and radiological criteria (node size, architecture loss, irregular margins) to stratify patients to DSNB vs ILND as opposed to clinical palpability alone.
11.2% i.e., 27/241 inguinal basins had lymph node positive disease by DSNB. 54.9% i.e., 39/71 inguinal basins (IBs) had lymph node-positive disease by ILND. 4 inguinal basins with no tracer uptake in sentinel node scans are being monitored at patient's request and have not had any recurrences to date. With a mean follow-up of 65 months (range 24-150), the false-negative rate (FNR) for DSNB is 0%. Judicious uses of cross-sectional imaging necessitated ILND in 2 inguinal basins with non-palpable nodes and negative US with false positive rate of 6.3% (2/32) for ILND. The same cohort of DSNB patients might have had 11.1% (3/27) FNR if only palpability criteria was used. 43 (28%) patients who did require cross sectional imaging as per our criteria had a low node positive rate of 4.7% (p = 0.03). Mean cancer specific survival of all node-positive patients was 105 months.
The performance of DSNB improved with enhanced radiological stratification of patients to either DSNB or ILND. We for the first time report the comprehensive outcome of all lymph node staging procedures in penile cancer.
淋巴结转移是阴茎癌患者生存的主要决定因素。传统上，临床触诊用于对临床淋巴结阳性（cN+）患者进行腹股沟淋巴结清扫术（ILND），或对临床淋巴结阴性（cN0）患者进行动态前哨淋巴结活检术（DSNB）。研究表明，DSNB 的假阴性率（FNR）约为 10%（5-13%）。据我们所知，目前尚无研究报告所有临床淋巴结阳性（cN+）患者的生存和结局的更硬终点。我们报告了所有阴茎癌患者的淋巴结手术结果数据，包括 DSNB 和 ILND 组的假阴性率和生存率。
2008 年 1 月至 2018 年，我们在三级转诊中心对 158 例连续阴茎癌患者（316 个腹股沟区）进行了淋巴结手术。所有患者均接受了超声（US）±细针抽吸细胞学（FNAC）检查，然后根据需要进行 MRI/CT 检查以分期疾病。我们使用临床和影像学联合标准（淋巴结大小、结构丢失、不规则边缘）对患者进行分层，以进行 DSNB 与 ILND ，而不仅仅是临床触诊。
11.2%（27/241 个腹股沟区）的 DSNB 淋巴结阳性。54.9%（39/71 个腹股沟区（IB））的 ILND 淋巴结阳性。4 个腹股沟区在进行前哨淋巴结扫描时没有示踪剂摄取，根据患者的要求进行监测，迄今为止没有任何复发。中位随访 65 个月（范围 24-150），DSNB 的假阴性率（FNR）为 0%。在 2 个无触诊淋巴结和 US 阴性的腹股沟区，由于横断面成像的合理使用，需要进行 ILND，ILND 的假阳性率为 6.3%（2/32）。如果仅使用触诊标准，同批 DSNB 患者可能有 11.1%（3/27）的 FNR。根据我们的标准，43 名（28%）需要进行横断面成像的患者淋巴结阳性率较低，为 4.7%（p=0.03）。所有淋巴结阳性患者的癌症特异性生存率平均为 105 个月。
通过增强对患者进行 DSNB 或 ILND 的影像学分层，DSNB 的性能得到了提高。我们首次报告了阴茎癌所有淋巴结分期手术的综合结果。
