pN0期阴茎癌患者接受预防性淋巴结清扫的标准及对预后的影响:一项单中心临床经验  

Criteria for prophylactic lymph node dissection and its impact on prognosis in patients with pN0 penile cancer:a single⁃center clinical experience

作　　者：宋伟杰 黄基崴 高军 徐志鹏 何乐业[1,2] Song Weijie;Huang Jiwei;Gao Jun;Xu Zhipeng;He Leye(Department of Urology,The Third Xiangya Hospital,Central South University,Changsha 410013,Hunan,China;Sexual Health Research Center,The Third Xiangya Hospital,Central South University,Changsha 410013,Hunan,China)

机构地区：[1]中南大学湘雅三医院泌尿外科,湖南长沙410013 [2]中南大学湘雅三医院性健康研究中心,湖南长沙410013

出　　处：《中国男科学杂志》2023年第6期22-28,共7页Chinese Journal of Andrology

摘　　要：目的 研究pN0期阴茎癌患者行阴茎切除术后接受预防性淋巴结清扫(preventive lymph node dissection, PLND)的标准及对患者预后的影响。方法 回顾性收集2010年4月至2021年9月入住我院的123例pN0期阴茎癌患者临床资料。根据患者的临床及病理资料以及是否符合中国阴茎癌诊治指南,将纳入研究的患者分为推荐淋巴结清扫组(recommended lymph node dissection group, RLNDG)和非推荐淋巴结清扫组(non-recommended lymph node dissection group, NRLNDG)。同时,根据组内实际进行PLND患者的临床资料和预后情况比较,分析不同情况下pN0期阴茎癌患者阴茎切除术后接受PLND对患者预后的影响。随访资料通过门诊和电话获取,以Kaplan-Meier描述患者的生存期。结果 在RLNDG中,行PLND患者的总生存时间(overall survival, OS)明显优于NPLND患者(P=0.029)。在NRLNDG中,PLND患者OS优于NPLND患者,但差异无统计学意义(P=0.062)。在NRLNDG的患者中,NPLND患者的白细胞及中性粒细胞计数均显著高于PLND患者(P=0.044;P=0.018)。RLNDG中的患者,无论是否行PLND临床资料间比较均无统计学差异。结论 符合中国阴茎癌诊治指南PLND标准的pN0阴茎癌患者,行PLND是必要的,可对患者的OS产生积极影响。然而对于未达到指南标准的pN0阴茎癌患者,行PLND几乎没有意义。Objective To investigate the criteria for preventive lymph node dissection(PLND)after penile resection and its effect on prognosis in patients with stage pN0 penile cancer(PC).Methods Review and collect clinical data of 123 pN0 stage penile cancer patients who were admitted to our hospital from April 2010 to September 2021.According to the patients’clinical and pathological data,as well as whether they comply with the Chinese guidelines for the diagnosis and treatment of penile cancer,the patients included in the study are divided into a recommended lymph node dissection group(RLNDG)and a non⁃recommended lymph node dissection group(NRLNDG).The clinical data and prognosis of stage pN0 PC patients with or without PLND were compared,respectively,and the necessity of PLND after penectomy in PC patients in different situations was analyzed and compared.A Kaplan⁃Meier analysis was performed using the collected outpatient and telephone follow⁃up data to effectively compare and analyze the data and any correlations.Results In RLNDG,the overall survival(OS)of PLND patients was significantly higher than that of NPLND patients(P=0.029).In NRLNDG,PLND patients had better OS than NPLND patients,but the difference was not statistically significant(P=0.062).Furthermore,among patients in NRLNDG,NPLND patients had significantly higher leukocyte and neutrophil counts than PLND patients(P=0.044;P=0.018).There was no statistical difference between the patients in RLNDG,whether or not PLND was performed.Conclusions PLND is necessary for pN0 PC patients who meet the criteria for PLND in Chinese guidelines for the diagnosis and treatment of PC,which can have a positive impact on the OS of patients.However,in patients with pN0 PC who do not meet guideline criteria,PLND is of little value.

关 键 词：阴茎肿瘤 淋巴结切除术 预后 

分 类 号：R737.27[医药卫生—肿瘤] R730.7[医药卫生—临床医学]