Fraley E E, Zhang G, Sazama R, Lange P H
Cancer. 1985 Apr 1;55(7):1618-24. doi: 10.1002/1097-0142(19850401)55:7<1618::aid-cncr2820550735>3.0.co;2-r.
Sixty-one patients with clinical low-stage (Jackson Stage I) and 22 patients with clinical high-stage (Jackson Stage II or III or T3-4N0-1M0) carcinoma of the penis who were seen between 1952 and 1979 and followed for at least 3 years or until death were reviewed. The majority of patients with Stage I cancer were treated with partial penectomy, either with or without ilioinguinal lymphadenectomy. The remainder of patients with these early small lesions were treated with local excision or circumcision. Forty-one of the patients with this early penile cancer (Jackson Stage I or Tcis, T1N0M0 or T2N0M0) survived at least 3 years and were considered cured. The other 20 patients died of cancer (12 cases) or unrelated disease (8 cases). If the patients who died of other diseases are excluded, the corrected 5-year survival rate was 77%. Treatment failure was primarily due to metachronous inguinal metastases after initial treatment of the primary tumor and failure of response of metastatic disease to salvage treatment. Four factors probably were associated with a poor prognosis: large primary tumor, moderately to poorly differentiated cancer, younger age at onset, and inadequate initial treatment. In advanced (Jackson Stages II and III) disease, treatment by partial or total penectomy alone or in combination with radiation to inguinal nodes after penectomy produced 3-year or longer survival in only 2 of 9 patients, whereas treatment by early extended excision of both the primary lesion and the ilioinguinal lymph nodes produced 3-year or longer survival in 11 of 13 patients. The results suggest that local excision is appropriate only for carcinoma in situ. Partial penectomy and monthly follow-up for at least 1 year is appropriate for patients with small, well-differentiated primary tumors. Patients who have large or moderately to poorly differentiated primary tumors probably should undergo partial or total penectomy and immediate ilioinguinal lymphadenectomy.
回顾了1952年至1979年间就诊的61例临床低分期（杰克逊I期）阴茎癌患者和22例临床高分期（杰克逊II期、III期或T3 - 4N0 - 1M0）阴茎癌患者，随访至少3年或直至死亡。大多数I期癌症患者接受了部分阴茎切除术，部分患者同时或未同时接受髂腹股沟淋巴结清扫术。其余这些早期小病灶患者接受了局部切除或包皮环切术。41例早期阴茎癌（杰克逊I期或Tis、T1N0M0或T2N0M0）患者存活至少3年，被认为已治愈。另外20例患者死于癌症（12例）或无关疾病（8例）。如果排除死于其他疾病的患者，校正后的5年生存率为77%。治疗失败主要是由于原发肿瘤初始治疗后出现异时性腹股沟转移以及转移性疾病对挽救治疗无反应。四个因素可能与预后不良相关：原发肿瘤大、癌细胞中度至低分化、发病年龄较轻以及初始治疗不充分。在晚期（杰克逊II期和III期）疾病中，单独行部分或全阴茎切除术或阴茎切除术后联合腹股沟淋巴结放疗，9例患者中仅2例存活3年或更长时间，而早期扩大切除原发灶及髂腹股沟淋巴结，13例患者中有11例存活3年或更长时间。结果表明，局部切除仅适用于原位癌。对于原发肿瘤小、分化良好的患者，部分阴茎切除术及至少1年的每月随访是合适的。原发肿瘤大或中度至低分化的患者可能应行部分或全阴茎切除术并立即行髂腹股沟淋巴结清扫术。
