Heyns C F, van Vollenhoven P, Steenkamp J W, Allen F J, van Velden D J
Department of Urology, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa.
Br J Urol. 1997 Aug;80(2):307-12. doi: 10.1046/j.1464-410x.1997.00229.x.
To evaluate variables for the prediction of lymph node metastases in carcinoma of the penis, using a recently proposed modified tumour-staging system that combines the histological degree of differentiation and extent of local invasion of the primary tumour.
Thirty-five patients with squamous carcinoma of the penis and histo- or cytological staging of the inguinal lymph nodes were reviewed. A clinical TNM staging system was used in which the size (diameter) of the primary tumour and the clinical extent of invasion were considered. Subsequently, the tumours were also staged according to a modified T-system in which the histological degree of differentiation and pathological extent of tumour invasion were combined.
Penectomy was performed in 34 patients (partial amputation in 20 and radical penectomy in 17). Inguinal lymphadenectomy was performed in 31 patients and in four the presence of lymph node metastases was confirmed by aspiration cytology. Using the clinical TNM staging system, lymph node metastases were histo- or cytologically present in no patients with T1, in five of 19 with T2, in 10 of 13 with T3 and in both patients with T4 tumours. Lymph node metastases were present in two of eight patients without clinically palpable inguinal nodes, in three of 14 with nodes clinically thought to be infective and in 11 of 12 nodes clinically considered to be malignant. Lymph node metastases were present in five of 17 patients with grade 1, in nine of 13 with grade 2 and in three of five with grade 3 tumours. Using the modified histological T-staging system (T1 = grade 1-2, invasive through dermis; T2 = any grade, invasion of corpus spongiosum or cavernosum; T3 = any grade, invasion of urethra; T4 = grade 3, regardless of invasion) lymph node metastases were present in one of nine patients with T1, in eight of 16 with T2, in all five with T3 and in three of five with T4 tumours.
The modified T-staging system, which combines histological differentiation with pathological extent of invasion, provided the best predictive distinction between T1 and T2-4 tumours, indicating that lymphadenectomy can be avoided in T1 tumours, but should be performed in all patients with T2-4 tumours. We recommend bilateral inguinal lymphadenectomy 6-8 weeks after penectomy in such patients.
使用最近提出的一种改良肿瘤分期系统（该系统结合了原发肿瘤的组织学分化程度和局部浸润范围）来评估阴茎癌淋巴结转移的预测变量。
回顾了35例阴茎鳞状细胞癌患者以及腹股沟淋巴结的组织学或细胞学分期情况。采用临床TNM分期系统，该系统考虑了原发肿瘤的大小（直径）和临床浸润范围。随后，肿瘤还根据一种改良的T系统进行分期，该系统将组织学分化程度和肿瘤浸润的病理范围结合起来。
34例患者接受了阴茎切除术（20例为部分切除术，17例为根治性阴茎切除术）。31例患者接受了腹股沟淋巴结清扫术，4例经穿刺细胞学检查证实存在淋巴结转移。使用临床TNM分期系统，T1期患者中无组织学或细胞学证实的淋巴结转移，T2期19例中有5例，T3期13例中有10例，T4期2例患者均有淋巴结转移。在8例腹股沟淋巴结无临床可触及的患者中有2例出现淋巴结转移，在14例临床认为有感染的淋巴结患者中有3例，在12例临床认为为恶性的淋巴结患者中有11例。1级肿瘤的17例患者中有5例出现淋巴结转移，2级肿瘤的13例中有9例，3级肿瘤的5例中有3例。使用改良的组织学T分期系统（T1 = 1 - 2级，浸润至真皮；T2 = 任何级别，侵犯海绵体或海绵体白膜；T3 = 任何级别，侵犯尿道；T4 = 3级，无论浸润情况），T1期9例患者中有1例出现淋巴结转移，T2期16例中有8例，T3期5例全部出现，T4期5例中有3例。
结合组织学分化与浸润病理范围的改良T分期系统，在区分T1期和T2 - 4期肿瘤方面具有最佳的预测能力，这表明T1期肿瘤可避免行淋巴结清扫术，但所有T2 - 4期患者均应进行该手术。我们建议此类患者在阴茎切除术后6 - 8周行双侧腹股沟淋巴结清扫术。
