Ornellas A A, Seixas A L, Marota A, Wisnescky A, Campos F, de Moraes J R
Department of Urology, Instituto Nacional de Cancer, Rio de Janeiro, Brazil.
J Urol. 1994 May;151(5):1244-9. doi: 10.1016/s0022-5347(17)35222-9.
Between 1960 and 1987, 414 patients with invasive squamous cell carcinoma of the penis were referred to the Brazilian National Cancer Institute. Inguinal metastases were demonstrated by lymphadenectomy in 39% of the 23 patients with stage N0, 49% of 92 with stages N1 and N2, and 100% of 18 with stage N3 disease. We analyzed the followup of 350 patients who underwent surgical treatment. In 224 patients (64%) amputation or some form of penile surgery was done initially, while 102 (29%) underwent amputation and lymphadenectomy, and 24 (7%) underwent palliative surgery for advanced squamous cell carcinoma. The statistics revealed a better 5-year survival rate for the patients who underwent lymphadenectomy concomitantly with penile surgery compared to those who underwent delayed lymphadenectomy (p < 0.001). Patients in whom systematic lymphadenectomy was negative had a better prognosis than those with positive systematic lymphadenectomy results (p < 0.001). The latter patients had a better prognosis compared with those in whom delayed lymphadenectomy was positive (p = 0.0103). Patients with well and moderately differentiated carcinoma had a higher survival rate at 5 years than did those with poorly differentiated carcinoma (p < 0.001 and p = 0.003, respectively). All deaths from metastatic disease occurred within 24 months among the patients who underwent systematic lymphadenectomy and within 5 years after simple penile surgery. In the short term, surgical debulking combined with reconstruction techniques allowed for improved quality of life in patients with advanced local-regional disease.
1960年至1987年间，414例阴茎浸润性鳞状细胞癌患者被转诊至巴西国家癌症研究所。在23例N0期患者中，39%通过淋巴结切除术证实有腹股沟转移；92例N1和N2期患者中，49%有转移；18例N3期患者中，100%有转移。我们分析了350例行手术治疗患者的随访情况。224例患者（64%）最初接受了截肢或某种形式的阴茎手术，102例（29%）接受了截肢和淋巴结切除术，24例（7%）因晚期鳞状细胞癌接受了姑息性手术。统计数据显示，与接受延迟淋巴结切除术的患者相比，阴茎手术同时进行淋巴结切除术的患者5年生存率更高（p<0.001）。系统性淋巴结切除术阴性的患者预后优于阳性患者（p<0.001）。后者患者的预后优于延迟淋巴结切除术阳性的患者（p = 0.0103）。高分化和中分化癌患者的5年生存率高于低分化癌患者（分别为p<0.001和p = 0.003）。接受系统性淋巴结切除术的患者中，所有因转移性疾病死亡均发生在24个月内，单纯阴茎手术后患者的死亡发生在5年内。短期内，手术减瘤联合重建技术可改善局部晚期疾病患者的生活质量。
