Mink Jan Niklas, Khalmurzaev Oybek, Pryalukhin Alexey, Geppert Carol Immanuel, Lohse Stefan, Bende Kristof, Lobo João, Henrique Rui, Loertzer Hagen, Steffens Joachim, Jerónimo Carmen, Wunderlich Heiko, Heinzelbecker Julia, Bohle Rainer M, Stöckle Michael, Matveev Vsevolod, Hartmann Arndt, Junker Kerstin
Department of Urology and Paediatric Urology, Saarland University, 66421 Homburg, Germany.
Department of Urology, Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology", Ministry of Health of the Russian Federation, Moscow 115478, Russia.
Cancers (Basel). 2023 Sep 27;15(19):4748. doi: 10.3390/cancers15194748.
Advanced penile carcinoma is characterized by poor prognosis. Most data on prognostic factors are based on small study cohorts, and even meta-analyses are limited in patient numbers. Therefore, there is still a lack of evidence for clinical decisions. In addition, the most recent TNM classification is questionable; in line with previous studies, we found that it has not improved prognosis estimation.
We evaluated 297 patients from Germany, Russia, and Portugal. Tissue samples from 233 patients were re-analyzed by two experienced pathologists. HPV status, p16, and histopathological parameters were evaluated for all patients.
Advanced lymph node metastases (N2, N3) were highly significantly associated with reductions in metastasis-free (MFS), cancer-specific (CS), and overall survival (OS) rates ( = <0.001), while lymphovascular invasion was a significant parameter for reduced CS and OS ( = 0.005; = 0.007). Concerning the primary tumor stage, a significant difference in MFS was found only between pT1b and pT1a ( = 0.017), whereas CS and OS did not significantly differ between T categories. In patients without lymph node metastasis at the time of primary diagnosis, lymphovascular invasion was a significant prognostic parameter for lower MFS ( = 0.032). Histological subtypes differed in prognosis, with the worst outcome in basaloid carcinomas, but without statistical significance. HPV status was not associated with prognosis, either in the total cohort or in the usual type alone.
Lymphatic involvement has the highest impact on prognosis in penile cancer, whereas HPV status alone is not suitable as a prognostic parameter. The pT1b stage, which includes grading, as well as lymphovascular and perineural invasion in the T stage, seems questionable; a revision of the TNM classification is therefore required.
晚期阴茎癌预后较差。大多数关于预后因素的数据基于小规模研究队列，甚至荟萃分析的患者数量也有限。因此，临床决策仍缺乏证据。此外，最新的TNM分类存在疑问；与先前研究一致，我们发现它并未改善预后评估。
我们评估了来自德国、俄罗斯和葡萄牙的297例患者。233例患者的组织样本由两位经验丰富的病理学家重新分析。对所有患者评估HPV状态、p16和组织病理学参数。
晚期淋巴结转移（N2、N3）与无转移生存期（MFS）、癌症特异性生存期（CS）和总生存期（OS）的降低高度显著相关（P<0.001），而淋巴管侵犯是CS和OS降低的重要参数（P = 0.005；P = 0.007）。关于原发肿瘤分期，仅在pT1b和pT1a之间发现MFS有显著差异（P = 0.017），而CS和OS在T类别之间无显著差异。在初次诊断时无淋巴结转移的患者中，淋巴管侵犯是MFS降低的重要预后参数（P = 0.032）。组织学亚型在预后方面存在差异，基底样癌预后最差，但无统计学意义。HPV状态在整个队列或仅在常见类型中均与预后无关。
淋巴管受累对阴茎癌预后影响最大，而单独的HPV状态不适合作为预后参数。包括分级以及T分期中的淋巴管和神经周围侵犯的pT1b分期似乎存在疑问；因此需要对TNM分类进行修订。
