Horenblas S, van Tinteren H, Delemarre J F, Moonen L M, Lustig V, van Waardenburg E W
Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoekhuis, Amsterdam.
J Urol. 1993 Mar;149(3):492-7. doi: 10.1016/s0022-5347(17)36126-8.
We analyzed the management of regional lymph nodes in 110 patients with squamous cell carcinoma of the penis treated at the Netherlands Cancer Institute between 1956 and 1989 with curative intent. Of 66 patients who presented with unsuspected nodes 57 were placed on a surveillance program, while lymph node dissection was performed in 5 (with adjuvant external radiation therapy in 1) and 4 were treated with external radiation therapy only. The management of 40 patients with clinically suspected nodes included surveillance in 5, lymph node dissection in 27 (with adjuvant radiotherapy in 11), biopsy in 4 and external radiation therapy in 4. Postoperative radiotherapy had been given if more than 2 nodes were involved or when extracapsular growth was observed. Overall, 25 patients had a regional recurrence, 5 of whom could be cured subsequently. All regional recurrences developed within 2 years after primary treatment. Analysis showed 100% survival in histologically proved node negative patients (stage pN0). The success of lymph node dissection was related to the extent of the metastatic spread and to the number of involved nodes. Patients with 1 positive node and unilateral inguinal involvement showed a statistically significant survival advantage compared to patients with more extensive spread. Considering the indications for node dissection we found a clear relationship among T category, grade and the probability of lymph node invasion. Patients with stage T1 tumors and stage T2, grades 1 and 2 tumors presented significantly less often with lymphatic invasion than those with other categories of disease and were less likely to have a regional recurrence after treatment of the primary tumor only. In these categories we recommend surveillance of the regional lymph nodes in patients who present with unsuspected nodes. However, patients with stage T2 grade 3, stage T3 and operable stage T4 tumors should undergo an immediate inguinal node dissection because of the high probability of clinically occult lymph node invasion (in our material more than 50%). With respect to the extent of the node dissection, we found that the likelihood of spread to the contralateral and/or pelvic regions was related to the number of invaded nodes in the inguinal region. We recommend contralateral node dissection and unilateral pelvic node dissection when 2 or more positive nodes are found in the dissected groin specimen. Primary pelvic node dissection should be performed in patients who present initially with cytologically or biopsy proved positive inguinal nodes.(ABSTRACT TRUNCATED AT 400 WORDS)
我们分析了1956年至1989年间在荷兰癌症研究所接受治疗、以治愈为目的的110例阴茎鳞状细胞癌患者区域淋巴结的处理情况。66例初诊时未怀疑有淋巴结转移的患者中，57例接受观察，5例进行了淋巴结清扫术（其中1例接受辅助外照射放疗），4例仅接受外照射放疗。40例临床怀疑有淋巴结转移的患者的处理包括：5例接受观察，27例进行淋巴结清扫术（其中11例接受辅助放疗），4例进行活检，4例接受外照射放疗。如果有超过2个淋巴结受累或观察到有包膜外生长，则给予术后放疗。总体而言，25例患者出现区域复发，其中5例随后得以治愈。所有区域复发均发生在初始治疗后的2年内。分析显示，组织学证实淋巴结阴性（pN0期）的患者生存率为100%。淋巴结清扫术的成功与否与转移扩散的程度及受累淋巴结的数量有关。与扩散范围更广的患者相比，有1个阳性淋巴结且单侧腹股沟受累的患者在统计学上显示出明显的生存优势。考虑到淋巴结清扫的指征，我们发现T分期、分级与淋巴结转移的可能性之间存在明确的关系。T1期肿瘤患者以及T2期1级和2级肿瘤患者出现淋巴转移的频率明显低于其他疾病类型的患者，并且仅在原发肿瘤治疗后发生区域复发的可能性也较小。对于这些类型的患者，我们建议对初诊时未怀疑有淋巴结转移的患者的区域淋巴结进行观察。然而，T2期3级、T3期和可手术的T4期肿瘤患者应立即进行腹股沟淋巴结清扫术，因为临床隐匿性淋巴结转移的可能性很高（在我们的资料中超过50%）。关于淋巴结清扫的范围，我们发现扩散至对侧和/或盆腔区域的可能性与腹股沟区域受累淋巴结的数量有关。当在清扫的腹股沟标本中发现2个或更多阳性淋巴结时，我们建议进行对侧淋巴结清扫和单侧盆腔淋巴结清扫。对于初诊时细胞学或活检证实腹股沟淋巴结阳性的患者，应进行原发性盆腔淋巴结清扫术。（摘要截选至400字）
