解剖部位对阴茎鳞癌预后的影响  

Effect of primary tumor location on survival outcomes for penile squamous cell carcinoma

作　　者：瞿元元[1] 朱耀[1] 戴波[1] 常坤[1] 张桂铭[1] 姚旭东[1] 张世林[1] 张海梁[1] 叶定伟[1] 

机构地区：[1]复旦大学附属肿瘤医院泌尿外科,复旦大学上海医学院肿瘤学系,上海200032

出　　处：《现代泌尿外科杂志》2013年第6期585-589,共5页Journal of Modern Urology

摘　　要：目的探讨肿瘤解剖部位与阴茎鳞癌患者临床病理特征的相关性及其对肿瘤特异性生存的影响。方法回顾性分析1998-2009年间美国“检测、流行病学和最终结果（SEER）”数据库中记录的1959例阴茎鳞癌患者的临床资料，包括地理区域、确诊年龄、种族、婚姻状况、肿瘤解剖部位、肿瘤分级、SEER分期及阴茎癌特异性生存情况等。根据肿瘤解剖部位对患者进行分组，采用Х^2检验比较各组患者的临床病理特征。运用Cox回归进行单因素及多因素生存分析。对生存函数的估计采用Kaplarr Meier法，并用Log-rank法对结果进行显著性检验。结果本组患者确诊时中位年龄68（21～106）岁，中位随访时间32（0～256）个月，至随访截止日期全组共有369例（18．8％）患者死于阴茎鳞癌。与肿瘤仅发生于包皮部位的患者相比，发生于其他部位的肿瘤分期较晚（P〈0．001）且分化较差（P=0．001）。多因素分析结果显示，肿瘤分级（P〈0．001）、SEER分期（P〈0．001）及解剖部位（P=0．026）均为阴茎鳞癌特异性生存的独立预后因素。此外，肿瘤侵犯包皮以外部位的患者其长期的肿瘤特异性生存率明显降低。结论肿瘤解剖部位可能为阴茎鳞癌特异性生存的预后因素，肿瘤发生于龟头、阴茎体部或累及多个部位的患者死于阴茎癌的风险显著高于肿瘤仅发生于包皮部位者。Objective To investigate the effect of primary tumor location on the clinicopathological characteristics and survival outcomes of patients with penile squamous cell carcinoma. Methods We retrospectively analyzed the data of 1 959 cases of penile squamous cell carcinoma reviewed in databases such as Surveillance, Epidemiology and End Results （SEER） from 1998 to 2009. Date collected included geographic region, age at diagnosis, race, marital status, primary site, tumor grade, SEER stage and cancer-specific survival. The chisquare test was used to Compare clinical and demographic data between patients with different tumor locations. Hazard ratios for the risk of cancer-specific mortality were determined using univariate and multivariate Cox regression models. Survival analysis was performed using Kaplan-Meier curves, and the differences in cancer-specific survival were assessed using the log-rank test. Results The median age was 68 years for the entire cohort, and the median follow-up time was 32 months. During the follow-up, 369 of the 1 959 patients （18.8%） died of penile squamous cell carcinoma. Patients with nonpreputial tumor locations had a greater incidence of advanced clinical stage （P〈0. 001） and greater tumor grade （P=0. 001）. Multivariate analysis revealed that primary tumor location （P = 0. 026）, along with clinical stage （P〈0. 001） and tumor grade （P〈0. 001）, might be an independent predictor of cancer-specific survival. In addition, Patients with tumor involving nonpreputatial regions of the penis showed significantly worse long-term cancer-specific survival. Conclusions Primary tumor location might be an independent predictor of cancer-specific survival for patients with penile squamous cell carcinoma. Tumors of nonpreputial origin had an increased relative risk of cancer-specific mortality compared with tumors of the prepuce.

关 键 词：阴茎肿瘤 预后 解剖部位 

分 类 号：R737.27[医药卫生—肿瘤]