阴茎癌根治术淋巴结清除数目和密度对预后预测意义分析  

Disease specific survival after radical inguinal lymphadenectomy for penile cancer: prediction by lymph node count and density

作　　者：李再尚[1] 韩辉[1] 邹子君[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泌尿外科.华南肿瘤学国家重点实验室.肿瘤医学协同创新中心,广东广州510060

出　　处：《中华肿瘤防治杂志》2014年第6期458-463,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：广东省科技计划项目(2012B031800079)

摘　　要：目的：探讨腹股沟淋巴结清除术后淋巴结数目及密度（lymph node density，LND）对阴茎癌患者预后的影响。方法：选择中山大学肿瘤防治中心2002-01-01-2012-12-31146例接受改良根治腹股沟淋巴结清除术阴茎癌患者，对临床病理资料进行回顾性研究。结果：146例阴茎癌患者随访3～124个月，中位随访时间36个月。淋巴结清除5～53枚，清除中位数22枚。以清除淋巴结数目16枚为界值，总体患者≥16枚5年疾病特异生存率（disease specific survival，DSS）为82．1％，与〈16枚52．0％比较，差异有统计学意义，P=0．031；淋巴结阴性（pN。）患者≥16枚5年DSS为92．1％，与〈16枚54．5％比较，差异有统计学意义，P一0．026。ROC曲线结果显示，LND在16％阈值时最有预测预后价值，淋巴结阳性（pN＋）患者LND〈16％和≥16％的5年DSS分别为80．6％和24．7％，差异有统计学意义，P〈0．001。单因素分析结果显示，淋巴结数目（P=0．019）、T分期（P=0．012）和辅助治疗（P=0．009）是总体患者的预后因素，淋巴结数目（P=0．005）和T分期（P=0．036）是pN。患者预后因素，LND（P=0．001）是pN＋患者预后因素；多因素分析显示，LND是预测淋巴结阳性患者预后的唯一独立因素，P=0．031。结论：淋巴结清除数目≥16枚能显著改善淋巴结阴性患者DSS，LND是预测淋巴结阳性患者预后的独立因素，但尚需外部资料进一步验证其有效性。OBJECTIVE： To investigate the value of removed lymph node （LN） count and LN density （LND） for predicting disease specific survival （DSS） following radical lymphadenectomy in penile cancer patients. METHODS： The case records of 146 penile cancer patients who were surgically treated between Jan. 1st 2002 and Dec. 31st,2012 in Cancer Center of Sun Yat-sen University were analyzed. RESULTS： Median follow-up was 36 months （IQR： 3-124）. The median number of removed LNs was 22 （IQR：5-53）. After stratification according to the number of LNs removed （≥16 vs 16） ,estimated 5-year DSS were 82.1% vs 52.0% for all patients （P=0. 031） ,92.1% vs 54.5% for pN0 patients （P= 0. 026）. ROC curve indicated that the most optimal LND cut-off value was 16%. The estimated 5-year DSS for pN＋ pa- tients with LND〈16% and ≥16% were 80.6% and 24.7% ,respectively （P〈0. 001）. Univariate analysis for the predic- tion of DSS revealed the following significant predictors in the entire population： T category （P=0. 012）, number of LNs removed （P=0. 019） and adjuvant therapy （P= 0. 009）. T category （P= 0. 036） and the number of LNs removed （P=0. 005） were statistically significant univariate predictors of DSS among pN0 patients. LND was a significant predictor of DSS （P= 0. 001） in pN＋ patients. In multivariate Cox regression models,LND （P= 0. 031） was the only independent predictor of DSS for pN＋ patients. CONCLUSIONS：The removal of at least 16 LNs is associated with a significantly longer DSS in patients with pN0 penile cancer. Additionally,LND above 16% is an independent predictor of DSS in pN＋ patients. Further in- dependent validation is required to determine the clinical usefulness of LN count and LND in this patient population.

关 键 词：阴茎肿瘤 淋巴结切除术 腹股沟 危险因素 预后 

分 类 号：R737.27[医药卫生—肿瘤]