Soria J C, Fizazi K, Piron D, Kramar A, Gerbaulet A, Haie-Meder C, Perrin J L, Court B, Wibault P, Théodore C
Department of Medicine, Institut Gustave-Roussy, Villejuif, France.
Ann Oncol. 1997 Nov;8(11):1089-98. doi: 10.1023/a:1008248319036.
Penile carcinoma is uncommon in Western countries. Here we report on a large series of patients with squamous cell carcinoma (SCC) of the penis, describing prognostic factors, survival and therapeutic results.
From 1973 to 1993, 102 patients with invasive SCC of the penis were treated at the Institut Gustave-Roussy. Precancerous lesions and conditions associated with penis cancer were analyzed retrospectively. Survival curves were estimated by the Kaplan-Meier method, and groups were compared for outcome by the log rank test for univariate comparisons and by Cox's proportional hazards model for multivariate analysis.
The median age at onset was 58 years. Sixty-nine patients presented with Jackson's stage I disease, 17 with stage II and 15 with stage III. The interval between the manifestation of symptoms and the diagnosis was more than a year in 13.7% of cases. Precancerous lesions were found in 17 (16.6%) patients, and a history of phimosis was noted in 25 (24.5%). In situ and invasive carcinoma were observed together in 17 (16.6%) cases and dysplasia was associated with invasive carcinoma in eight (7.8%) further cases. Conservative treatment was administered whenever feasible. Interstitial brachytherapy was performed alone or associated with limited surgery (local excision or circumcision) in 72 (70.6%) patients. Of the 28 patients with a local relapse, nine have died of their neoplasms (32%) compared to 21 of 28 patients with lymph node relapse (75%). The median follow-up was 111 months. Disease-free survival, disease-specific survival and overall survival were, respectively, 56%, 72% and 63% at five years and 42%, 66% and 50% at 10 years. Age (P = 0.01), the N status (P < 0.00001) or palpable nodes (P < 0.0038), corpus involvement (P = 0.006) and a verrucous histology (P = 0.038) had significant prognostic relevance for survival in the univariate analysis whereas the performance status, T status and Broders' grade did not. In the multivariate analysis only two parameters, involvement of the corpus (P < 0.0001) and palpable nodes (P = 0.009), were singled out as being independent variables influencing survival. A subgroup of nine patients with verrucous histologies were distinguished by their freedom from node involvement. These patients had an excellent prognosis: all are alive and disease-free. Penile integrity was preserved during follow-up in 54 patients (52.9%), 31 of whom are still alive. Of 72 patients treated by a conservative approach including brachytherapy, long-term penile integrity was maintained in 49 (68%).
Corpus involvement and clinically palpable nodes are highly statistically significant independent factors influencing overall survival. Node relapses remain a major cause of death. Thus, better management of lymph nodes is essential for improving survival even when conservative therapy is used to treat the primary.
阴茎癌在西方国家并不常见。在此，我们报告了一大系列阴茎鳞状细胞癌（SCC）患者，描述了预后因素、生存率及治疗结果。
1973年至1993年期间，古斯塔夫 - 鲁西研究所共治疗了102例阴茎浸润性SCC患者。对癌前病变及与阴茎癌相关的情况进行了回顾性分析。采用Kaplan - Meier法估计生存曲线，通过对数秩检验进行单因素比较以比较各亚组的结局，通过Cox比例风险模型进行多因素分析。
发病的中位年龄为58岁。69例患者为杰克逊I期疾病，17例为II期，15例为III期。13.7%的病例症状出现与诊断之间的间隔超过一年。17例（16.6%）患者发现有癌前病变，25例（24.5%）有包茎病史。17例（16.6%）病例同时观察到原位癌和浸润癌，另外8例（7.8%）发育异常与浸润癌相关。只要可行，就进行保守治疗。72例（70.6%）患者单独或联合有限手术（局部切除或包皮环切术）进行了组织间近距离放疗。在28例局部复发的患者中，9例死于肿瘤（32%），而28例淋巴结复发患者中有21例（75%）死亡。中位随访时间为111个月。五年时无病生存率、疾病特异性生存率和总生存率分别为56%、72%和63%，十年时分别为42%、66%和50%。在单因素分析中，年龄（P = 0.01）、N分期（P < 0.00001）或可触及淋巴结（P < 0.0038）、阴茎体受累（P = 0.006）以及疣状组织学类型（P = 0.038）对生存具有显著的预后相关性，而体能状态、T分期和布罗德斯分级则不然。在多因素分析中，仅两个参数，即阴茎体受累（P < 0.0001）和可触及淋巴结（P = 0.009），被确定为影响生存的独立变量。9例具有疣状组织学类型的患者亚组因其无淋巴结受累而具有独特性。这些患者预后极佳：全部存活且无病。随访期间54例患者（52.9%）阴茎完整性得以保留，其中31例仍存活。在72例采用包括近距离放疗在内的保守方法治疗的患者中，49例（68%）长期保持了阴茎完整性。
阴茎体受累和临床可触及淋巴结是影响总生存的具有高度统计学意义的独立因素。淋巴结复发仍然是主要的死亡原因。因此，即使采用保守疗法治疗原发肿瘤，更好地处理淋巴结对于提高生存率也至关重要。
