阴茎鳞状细胞癌腹股沟淋巴结转移的危险因素分析  

Risk factors predicting inguinal node metastasis in squamous cell cancer of penis

作　　者：卢可士[1] 陈明坤[2] 周芳坚[1] 韩辉[1] 刘卓炜[1] 李永红[1] 尧凯[1] 刘建业[1] 秦自科[1] 

机构地区：[1]华南肿瘤学国家重点实验室中山大学肿瘤防治中心泌尿外科,广州510060 [2]中山大学附属第三医院泌尿外科

出　　处：《中华泌尿外科杂志》2011年第4期273-277,共5页Chinese Journal of Urology

摘　　要：目的探讨阴茎鳞状细胞癌腹股沟淋巴结转移的危险因素，筛选淋巴结转移的高危患者。方法回顾性分析81例阴茎鳞状细胞癌患者临床及病理资料。年龄27～81岁，中位年龄49岁。病程〈1年者46例（56．8％），≥1年者35例（43．2％）。行单侧腹股沟淋巴结清扫6例，双侧腹股沟淋巴结清扫75例。按2002年TNM分期标准进行分期，并记录患者年龄、有无包皮过长／包茎史、肿瘤部位、大小、数目、形状、分级、腹股沟淋巴结体格检查情况和淋巴结大小等指标。结果81例患者中经病理证实有区域淋巴结转移者pN＋42例（51．9％），无淋巴结转移者pN0 39例（48．1％）。G1、G2、G3患者区域淋巴结转移发生率分别为32．0％（16／50）、78．3％（18／23）和100．0%（8／8），各组问比较差异有统计学意义（P=0．015）。根据腹股沟淋巴结体格检查结果，cN＋和cN0患者区域淋巴结转移发生率分别为63．5％（40／63）和11．1％（2／18），2组差异有统计学意义（P=0．012）。81例均获随访，随访时间2～127个月，中位时间40个月。腹股沟淋巴结转移阳性患者与阴性患者的5年无病生存率分别为71．4％与92．3％（P=0．005），5年总生存率分别为79．0％与91．4％（P=0．001），差异均有统计学意义。结论腹股沟淋巴结体格检查结果和肿瘤分级是腹股沟区域淋巴结转移的独立危险因素。腹股沟淋巴结转移患者5年无病生存率和总生存率较低，对淋巴结转移高危患者，应采取积极治疗措施。Objective To explore the risk factors of inguinal metastasis in squamous cell carci noma of the penis, screening lymph node metastasis high risk patients. Methods The clinical and pathological data of 81 consecutive patients with squarnous cell carcinoma of the penis were analyzed retrospectively. Age at presentation ranged from 27 to 81 years with a median of 49 years. Course of disease within one year of patients with 46 cases （56.8%）, 1 year above 35 cases （43.2%）. Seventy- five patients underwent bilateral inguinal lymph node dissection, and 6 patients had unilateral inguinal lymph node dissection. Clinical stage of the primary tumor was assigned according to the 2002 TNM staging system. Variables included patients＇ age, redundant prepuce and/or phimosis, tumor site, size, number, macroscopic growth pattern, histological grade, inguinal physical examination and the size of inguinal lymph nodes. Results Of the 81 patients, 42 （51.9%） were staged as pN＋ and 39 （48.1%） as pN0. Metastases occurred in 32.0% （16/50） of G1, 78.3% （18/23） of G2 and 100.0M （8/8） of G3 cases, with significant differences among them （P=0. 015）. According to the inguinal lymph node physical examination results, 63 were staged as clinically node-positive （cN＋） and 18 as clinically node negative （cN0）. Metastases occurred in 63.5% （40/63） of cases of cN＋ , as compared with 11.1% （2/18） ofeasesofeN0（P 0.012）. At a median follow up of 40 months （ranged 2-127 months）, the 5 year disease free survival rates for positive and negative inguinal lymph nodes metasta- sis were 71.4% and 92.3%, respectively （P=0. 005） , and the 5 year cancer specific survival rates were 79.0% and 91.4%, respectively （P=0. 001）, Conclusions Inguinal physical examination and histological grade were the strongest predictors of inguinal metastasis. The patients with inguinal lymph nodes metastasis have lower 5 year disease free survival rates and cancer specific survival rates, and should receive pos

关 键 词：阴茎肿瘤 癌 鳞状细胞 腹股沟转移 危险因素 存活率分析 

分 类 号：R737.27[医药卫生—肿瘤]