第7版阴茎癌病理N分期验证:单中心110例患者分析  

Validation of the 7th Edition Pathological N Staging System for Penile Cancer: An Analysis of 110 Patients in a Single Center

作　　者：李再尚[1] 韩辉[1] 周芳坚[1] 秦自科[1] 刘卓炜[1] 李永红[1] 尧凯[1] 

机构地区：[1]中山大学肿瘤防治中心∥华南肿瘤学国家重点实验室∥肿瘤医学协同创新中心泌尿外科,广东广州510060

出　　处：《中山大学学报（医学科学版）》2013年第6期973-978,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科技计划项目(2012B031800079)

摘　　要：【目的】探讨第7版国际抗癌联盟—美国癌症联合委员会(UICC—AJCC)阴茎癌病理N分期是否具有更好的预测预后价值。【方法】1999年到2012年共110例病理证实淋巴结转移阴茎鳞状细胞癌患者,按照第6版和7版UICCAJCC病理N分期系统分期。Kaplan-Meier法进行疾病特异性生存率(DSS)分析并采用Log-rank检验进行比较。Logistic回归分析进行预测模型比较,概率比卡方检验(LR)、AIC标准和c-index一致性系数作为预测模型的评估标准。【结果】中位随访时间36个月,第6版分期pN1、pN2、pN3患者的3年DSS分别为89.6%、55.2%和32.5%,pN2与pN3患者之间生存差异无统计学意义(P=0.276)。按照第7版病理N分期标准,旧版pN2期患者中16例升期为pN3,6例pN3期患者降期为pN2。第7版分期pN1,pN2,pN3患者的3年DSS分别为89.6%、65.0%和31.2%,各组之间的DSS差异有统计学意义(P<0.05)。淋巴结结外侵犯和结内转移患者,3年DSS分别为73.1%和23.9%(P<0.001)。模型评估结果显示第7版病理N分期系统具有更好的预测预后准确度。【结论】UICC-AJCC第7版病理N分期能更好地预测阴茎癌患者预后。[Objective] To validate the predictive value of the 7th edition pathological N staging system of Union for International Cancer Control-American Joint Committee on Cancer （UICC-AJCC） for penile cancer patients externally using our own data.[Methods] The case records of 110 penile cancer patients with positive lymph nodes between 1999 and 2012 were analyzed.All cases were staged according to the 6th and 7th pathological N staging system of UICC-AJCC for penile cancer.The survival was analyzed by Kaplan-Meier and test by Log-rank test.Predictive accuracy was assessed by Logistic with LR,AIC and the Harrell c-index.[Results] Median follow-up was 36 months in all patients.Using the 6th N classification the 3-year disease specific survival （DSS） was 89.6%,55.2%,and 32.5% for the N1,N2,and N3 categories,respectively.Log rank survival analysis failed to show a statistical difference between patients with pN2 and pN3 disease （P =0.276）.For the new 7th N categories the 3-year DSS were 89.6%,65.0%,and 31.2% in the corresponding N1 to N3 groups.Better survival stratification was observed on analysis （P 〈 0.05）.Patients with extranodal extension had significantly decreased 3-year DSS compared with patients without it （23.9% vs 73.1%,P 〈 0.001）.Adding extranodal extension significantly increased the accuracy of the 7th N category to predict DSS.[Conclusion] The new pathological N staging system better reflects the prognosis in patients with penile cancer.

关 键 词：阴茎肿瘤 肿瘤分期 淋巴结转移 淋巴结切除 预后 

分 类 号：R737.2[医药卫生—肿瘤]