46例阴茎癌的临床分析及总结——附文献复习

背景与目的:阴茎癌是一种少见的疾病,以鳞状细胞癌为主,主要通过淋巴途径转移.治疗包括局部原发癌切除和对转移淋巴结的处理及放疗、化疗等辅助治疗.本研究旨在探讨阴茎癌合理的治疗方法.方法:对中山大学附属第一医院1996年1月至2005年1月收治的46例阴茎癌患者的临床资料进行回顾性分析,46例患者中鳞状细胞癌44例,Paget病1例,疣状癌1例,对其中23例肿大淋巴结进行活检.结果:39例行阴茎部分切除术,4例行阴茎全切加会阴部尿道造口术治疗,1例Paget病患者行病灶切除植皮术,2例未接受手术治疗.10例淋巴结活检阳性的患者中有9例行腹股沟淋巴结清扫术,5例行同期盆腔淋巴结清扫术.41例患者获定期随访1～10年,1年、2年、5年、10年生存率分别为95.1%、95.1%、82.9%、31.7%.术后病理证实有盆腔淋巴结转移者2例均在2年内死于肺转移.结论:阴茎部分切除术是治疗阴茎癌合理有效的方法,且应尽早手术治疗.淋巴结转移是影响阴茎癌预后的重要因素,有腹股沟淋巴结转移者应早期行淋巴结清扫术治疗,以提高治疗效果.有盆腔淋巴结转移者预后差.     

阴茎癌32例诊治体会

目的:探讨阴茎癌有效合理的诊断及治疗方法。方法:回顾性分析32例阴茎癌患者的临床资料,其中鳞状细胞癌29例,鳞状上皮乳头状瘤恶变2例,疣状癌1例。31例行手术治疗,首次治疗行单纯肿瘤切除+包皮环切术+放疗3例,阴茎部分切除术27例,阴茎全切+尿道会阴部造口术1例,其中行双侧腹股沟淋巴结清扫术4例。结果:28例获得随访,行单纯肿瘤切除+包皮环切术中1例于手术后3年复发和2例于手术后3月复发而行阴茎部分切除术,行阴茎部分切除术者2年和5年及10年生存率分别为92%、82%和45%,行阴茎全切除术者随访6年至今仍健在。结论:阴茎部分切除术是治疗阴茎癌合理有效的方法,且应尽早治疗。证实有淋巴结转移者应积极行腹股沟淋巴结清扫术。     

阴茎癌32例诊治体会

目的：探讨阴茎癌有效合理的诊断及治疗方法。方法：回顾性分析32例阴茎癌患者的临床资料,其中鳞状细胞癌29例,鳞状上皮乳头状瘤恶变2例,疣状癌1例。31例行手术治疗,首次治疗行单纯肿瘤切除＋包皮环切术＋放疗3例,阴茎部分切除术27例,阴茎全切＋尿道会阴部造口术1例,其中行双侧腹股沟淋巴结清扫术4例。结果：28例获得随访,行单纯肿瘤切除＋包皮环切术中1例于手术后3年复发和2例于手术后3月复发而行阴茎部分切除术,行阴茎部分切除术者2年和5年及10年生存率分别为92%、82%和45%,行阴茎全切除术者随访6年至今仍健在。结论：阴茎部分切除术是治疗阴茎癌合理有效的方法,且应尽早治疗。证实有淋巴结转移者应积极行腹股沟淋巴结清扫术。     

阴茎癌外科治疗36例分析

36例阴茎癌其中鳞状细胞癌34例,鳞状上皮乳头状瘤恶变2例;行阴茎部分切除术32例,阴茎全切除并尿道会阴部造口术4例;行腹股沟淋巴结清扫术14例(22侧),行髂淋巴结清扫术4例(6侧);伴淋巴结转移者行患侧放疗.阴茎部分切除术后3例发生尿道外口狭窄,经反复尿扩后好转;行腹股沟淋巴结清扫患者中8例(10侧)发生皮瓣感染坏死,6例(7侧)经换药后治愈,2例(3侧)经植皮后愈合;30例获得随访,1、2、5年生存率分别为80.0%、70.6%和63.0%.     

不同时期淋巴结清扫术对阴茎癌预后的影响

目的 回顾性分析295例阴茎癌的临床资料,比较阴茎癌不同时期行双侧腹股沟淋巴结清扫对预后的影响,探讨阴茎癌有效合理的手术治疗方法。方法 回顾性调查随访哈尔滨医科大学附属第三医院和解放军第二一一医院的295例阴茎癌患者,收集年龄、职业、病理、Jackson分期、淋巴结转移等可能影响其生存情况的因素。按照一期是否行双侧腹股沟淋巴结清扫术将患者分为两组,采用Log-rank检验、Cox回归等统计方法分别比较淋巴结有转移情况和无转移情况下两组患者的生存预后。结果 295例患者均获得随访。一期手术患者212人,二期手术患者83人。无淋巴结转移情况下,一期组5年生存率为96.12%;二期组为80.00%,有淋巴转移情况下,一期组5年生存率为91.30%,二期组为50.80%,不同淋巴结转移情况下一期组生存率均高于二期组(χ²=37.406,P＜0.001;χ²=53.427,P＜0.001)。经Cox回归分析,不同时期行淋巴结清扫术、年龄、化疗药物对预后的影响显著。结论 阴茎部分切除术或阴茎全切除术同时行双侧腹股沟淋巴结清扫术是治疗阴茎癌十分合理和有效的方法,根治术同期行腹股沟淋巴结转移生存率与二期行双侧腹股沟淋巴结清扫术有显著差异。     

阴茎癌术后短期肺转移3例报道并文献复习

目的:探讨阴茎癌术后短期肺转移的疾病进展、影像学表现、病理、治疗及预后情况。方法:通过回顾分析3例阴茎癌肺转移患者的临床资料,结合相关文献进行讨论。结果:3例患者,平均年龄65岁,术前平均体质量指数(body mass index, BMI)为21.2 kg/m²,术前胸部CT均未见明显肺转移。3例患者术前均可触及肿大腹股沟淋巴结,其中1例盆腔磁共振可见淋巴结肿大。活检病理2例为低分化鳞状细胞癌,1例为中分化鳞状细胞癌。1例患者接受了阴茎部分切除术+腹股沟及盆腔淋巴结清扫术,2例患者接受阴茎部分切除术+腹股沟淋巴结清扫术。术后病理肿瘤直径3.0～5.2 cm,均提示阴茎低分化鳞状细胞癌。免疫组化：CK(+)、p40(+)、Vimentin(+)、CK5/6(+)、HCK(+)、p63(+), Ki-67均大于70%。3例患者术后1个月复查胸部CT均提示多发结节。其中1例患者术后1个月出现咯血症状,腹股沟区可触及肿块,肺结节穿刺病理证实阴茎癌肺转移。术后3例患者总生存期均≤5个月。结论:阴茎癌术后短期出现肺转移临床少见,术前多有区域淋巴结转移,术后进展迅速,可合并有...     

阴茎癌71例临床分析

目的　探讨阴茎癌最佳治疗方式。方法　 1971年 1月～ 1995年 1月手术治疗阴茎癌 71例 ,其中局部及包皮环切术 5例 ,阴茎部分切除 14例 ,阴茎全切除 2 3例 ,阴茎切除加腹股沟淋巴结清扫 2 9例。结果　获得随访 5 9例 ,其中局部及包皮环切术 5例 ,复发3例。阴茎部分切除加全切除 3 0例 ,死亡 12例 ,死亡率 40 %。阴茎切除加腹股沟淋巴结清扫 2 4例 ,死亡 8例 ,死亡率 3 3 .3 %。结论阴茎癌仍以手术为主 ,确切掌握腹股沟淋巴结清扫指征是提高生存率的关键。而肿瘤病理分级对患者预后起决定性作用。     

同期腹腔镜下双侧腹股沟淋巴结清扫术在阴茎癌手术中的应用

目的 探讨同期腹腔镜下双侧腹股沟淋巴结清扫术在阴茎癌手术中的临床应用价值。方法 回顾性分析2012年4月至2014年8月采用该手术方法治疗的14例阴茎鳞状细胞癌患者的临床资料。结果所有手术均顺利完成,手术平均时间112 min,术中平均出血量47 ml,平均住院时间10 d;平均切除淋巴结数量为9.1枚,14例共28处腹股沟淋巴结中,2处有5枚淋巴结发生转移。术后1例患者右侧下肢出现皮下积液伴高热,经治疗后好转,其余患者无明显并发症。术后随访2～48个月,所有患者均无肿瘤复发和转移。结论 阴茎癌同期行腹腔镜双侧淋巴结清扫术具有术中出血少、术后恢复快、住院时间短、并发症少等优点,是一项安全有效的手术。     

双侧腹股沟淋巴结转移对淋巴结阳性阴茎癌预后评估的价值

目的探讨双侧腹股沟淋巴结转移在淋巴结阳性阴茎癌预后评估中的价值。方法回顾性分析60例淋巴结转移阳性阴茎鳞状细胞癌患者资料。所有患者均接受区域淋巴结清扫手术。Kaplan-Meier法绘制无复发生存曲线并通过Log—rank检验加以分析,COX回归模型进行多因素生存分析。结果60例患者中18例有双侧腹股沟淋巴结转移,其3年无复发生存率（26．7％）显著低于单侧腹股沟淋巴结转移患者（65．3％）,差异有统计学意义（x^2=10．6,P=0．001）。经多因素生存分析,阳性淋巴结数目和双侧腹股沟淋巴结转移均是独立的生存预后因素（均P〈0．05）。生存曲线比较显示双侧腹股沟淋巴结转移且阳性淋巴结数〉2个的患者预后差。结论在考虑了淋巴结阳性阴茎癌阳性淋巴结数目的影响后,双侧腹股沟淋巴结转移仍是其重要预后指标。     

阴茎癌71例临床分析

目的 探讨阴茎癌最佳治疗方法。方法 １９７１年１月～１９９５年１月手术治疗阴茎癌７１例，其中局部及包皮环切术５例，阴茎部分切除１４例，阴茎全切除２３例，阴茎切除加腹股沟淋巴结清扫２９例。结果 获得随访５９例，其中局部及包皮环切术５例，复发３例。阴茎部分切除加全切除３０例，死亡１２例，死亡率４０％。阴茎切除加腹股沟淋巴结清扫２４例，死亡８例，死亡率３３．３％。结论 阴茎癌仍以手术为主，确切掌握腹股沟淋巴结清扫指征是提高生存率的关键，而肿瘤病理分级对患者预后起决定性作用。     

CLINICOPATHOLOGICAL AND SURGICAL STUDY OF VERRUCOUS CARCINOMA OF PENIS

ＣＬＩＮＩＣＯＰＡＴＨＯＬＯＧＩＣＡＬＡＮＤＳＵＲＧＩＣＡＬＳＴＵＤＹＯＦＶＥＲＲＵＣＯＵＳＣＡＲＣＩＮＯＭＡＯＦＰＥＮＩＳＷａｎｇＸｕｚｈｏｕ；ＺｈａｎｇＺｉｘｕａｎ；ＧａｏＺｈｏｎｇｙｕ；ＬｉａｎｓＳｉｔａｉ；ＴｉａｎＪｉｘｉ王绪洲，张紫萱，高促...     

Outcomes after radiotherapy for basaloid squamous cell carcinoma of the head and neck: a case-control study

BACKGROUND: Basaloid squamous cell carcinoma (BSCC) is an uncommon, high-grade variant of squamous cell carcinoma (SCC) of the head and neck. Its poorer prognosis compared with common SCC remains controversial. The authors investigated the outcomes of patients with BSCC who received radiotherapy and compared them with the outcomes of patients with SCC. METHODS: From 1994 to 2004, 1007 patients received radiotherapy for head and neck carcinoma with lymph node involvement. The histologic types consisted of 51 BSCC, 431 poorly differentiated SCC (PSCC), and 525 well or moderately differentiated SCC (WMSCC). A case-control analysis was performed with BSCC matched against both PSCC and WMSCC to compare disease-control and survival rates. RESULTS: Patients with BSCC received treatment modalities similar to those received by patients with SCC: They received induction chemotherapy (12%) or concurrent chemotherapy (33%), and a median radiation dose of 70 Gray. Posttreatment viable tumor was present in 44%, 13%, and 28% of neck dissection specimens from patients with BSCC, PSCC, and WMSCC, respectively. The 5-year disease-free survival rates (63%, 77%, and 76%, respectively) and overall survival rates (85%, 70%, and 71%, respectively) demonstrated no statistically significant differences for BSCC, PSCC, or WMSCC, respectively. CONCLUSIONS: In this study, a poorer prognosis could not be demonstrated for irradiated patients with BSCC compared with either PSCC or WMSCC. All patients in this study had positive lymph node status, and the majority of patients (84%) had oropharyngeal cancer. The BSCC cohort did have a relatively high rate of viable tumor in their posttreatment neck dissections, and they had a relatively high rate of distant disease. On the basis of the high rate of lung metastases and the possibility of efficient salvage, the authors recommend obtaining a chest computed tomography scan during initial staging and follow-up.     

Ivor Lewis食管切除术二野淋巴清扫治疗73例胸下段食管鳞癌的临床疗效

背景与目的:食管切除局部区域淋巴清扫是胸下段食管癌的主要治疗手段.本研究旨在评价Ivor Lewis食管切除术二野淋巴清扫治疗胸下段食管癌的临床效果.方法:选择1998年1月至2001年12月73例行Ivor Lewis食管切除术二野淋巴清扫的胸下段食管鳞癌病例,观察清扫的淋巴结数目、术后并发症发生率、死亡率等指标,Kaplan-Meier法进行生存分析.结果:术后并发症发生率15.1%,死亡率2.7%.淋巴结转移率71.2%,上纵隔淋巴转移率17.8%.Ⅰ期5例,Ⅱ期34例,Ⅲ期32例,Ⅳ期2例.总的5年生存率为23.3%.N0与M病例5年生存率分别为38.1%与17.3%(P＜0.01).ⅡA、ⅡB、Ⅲ期病例的5年生存率分别是31.2%、27.8%、12.5%(P＜0.01).结论:Ivor Lewis食管切除术二野淋巴清扫治疗胸下段食管鳞癌是一项安全的手术,可增加完整切除(肉眼及镜下均无癌残留)机会.     

51例食管基底细胞样鳞癌外科治疗及预后分析

目的：食管基底细胞样鳞癌（basaloid squamous cell carcinoma of the esophagus,BSCCE）是一类少见的具有独特病理特征的鳞癌亚型,本研究旨在探讨 BSCCE 的临床特征及预后。方法回顾性分析经手术和病理证实的51例 BSCCE 患者的临床资料,并与同期手术的食管低分化鳞癌患者进行生存比较。结果51例BSCCE 患者,包括Ⅰ期5例,Ⅱ期28例,Ⅲ期18例。其中35例患者接受胃镜检查,仅有4例（11.5%）被诊断为基底细胞样癌。所有 BSCCE 患者的中位生存期为31个月,1年、3年、5年总生存率分别为81.6%、45.9%和29.5%;同期典型食管低分化鳞癌患者的中位生存期为32.5个月,1年、3年、5年总生存率分别为76.1%、47.8%和32.4%（P=0.821）。Cox 多因素分析显示,肿瘤发生部位、病理 TNM 分期均是影响 BSCCE 手术预后的独立因素。结论 BSCCE 恶性程度高,其预后与食管低分化鳞癌相近。     

Bilateral ilioinguinal lymph node dissection in the management of cancer of the penis

Twenty-nine patients with squamous cell carcinoma of the penis underwent bilateral ilioinguinal groin dissection 6 weeks after removal of the primary penile lesion. Eighty percent of the patients were alive and without evidence of disease at 5 years when the dissected lymph nodes were negative. When positive nodes were found, 62.5% of the patients were alive and without evidence of disease at 5 years: two of these patients had one iliac deep node positive each. The mortality rate at 5 years because of progression of disease was 6.6% when the dissected lymph nodes were negative, as compared to 37.5% when the dissected lymph nodes were positive.     

Squamous cell carcinoma of the penis: Multivariate analysis of prognostic factors and natural history in a monocentric study with a conservative policy

Background: Penile carcinoma is uncommon in Western countries. Here we report on a large series of patients with squamous cell carcinoma (SCC) of the penis, describing prognostic factors, survival and therapeutic results.Patients and methods: From 1973 to 1993, 102 patients with invasive SCC of the penis were treated at the Institut Gustave-Roussy. Precancerous lesions and conditions associated with penis cancer were analyzed retrospectively. Survival curves were estimated by the Kaplan–Meier method, and groups were compared for outcome by the log rank test for univariate comparisons and by Cox's proportional hazards model for multivariate analysis.Results: The median age at onset was 58 years. Sixty-nine patients presented with Jackson's stage I disease, 17 with stage II and 15 with stage III. The interval between the manifestation of symptoms and the diagnosis was more than a year in 13.7% of cases. Precancerous lesions were found in 17 (16.6%) patients, and a history of phimosis was noted in 25 (24.5%). In situ and invasive carcinoma were observed together in 17 (16.6%) cases and dysplasia was associated with invasive carcinoma in eight (7.8%) further cases.Conservative treatment was administered whenever feasible. Interstitial brachytherapy was performed alone or associated with limited surgery (local excision or circumcision) in 72 (70.6%) patients. Of the 28 patients with a local relapse, nine have died of their neoplasms (32%) compared to 21 of 28 patients with lymph node relapse (75%).The median follow-up was 111 months. Disease-free survival, disease-specific survival and overall survival were, respectively, 56%, 72% and 63% at five years and 42%, 66% and 50% at 10 years. Age (P = 0.01), the N status (P < 0.00001) or palpable nodes (P < 0.0038), corpus involvement (P = 0.006) and a verrucous histology (P = 0.038) had significant prognostic relevance for survival in the univariate analysis whereas the performance status, T status and Broders' grade did not. In the multivariate analysis only two parameters, involvement of the corpus (P < 0.0001) and palpable nodes (P = 0.009), were singled out as being independent variables influencing survival. A subgroup of nine patients with verrucous histologies were distinguished by their freedom from node involvement. These patients had an excellent prognosis: all are alive and disease-free. Penile integrity was preserved during follow-up in 54 patients (52.9%), 31 of whom are still alive. Of 72 patients treated by a conservative approach including brachytherapy, long-term penile integrity was maintained in 49 (68%).Conclusion: Corpus involvement and clinically palpable nodes are highly statistically significant independent factors influencing overall survival. Node relapses remain a major cause of death. Thus, better management of lymph nodes is essential for improving survival even when conservative therapy is used to treat the primary.     

口腔鳞癌颈淋巴结转移的临床病理学特点及其对预后的影响

背景与目的口腔癌淋巴结转移率在50%～59%之间,对其处理好坏关系到患者的预后。本研究拟探讨影响口腔鳞癌颈淋巴结转移的临床病理因素及其对预后的影响。方法对191例口腔鳞癌患者的临床病理学因素与颈淋巴结转移的关系进行回顾性研究,并对颈淋巴结转移状态、转移颈淋巴结大小、转移颈淋巴结数目、转移颈淋巴结累及区域、转移颈淋巴结最低受累区域等淋巴结病理学因素对预后生存的影响进行Cox回归分析。结果口腔鳞癌患者5年生存率为48.7%。χ2分析显示,仅肿瘤浸润深度与发生颈淋巴结转移有关。Cox回归分析表明,临床N分期、颈淋巴结转移状态、转移颈淋巴结累及区域数、转移颈淋巴结最低受累区域因素影响患者预后,特别是临床N分期、转移颈淋巴结最低受累区域因素与口腔鳞癌患者预后明显相关。结论口腔鳞癌颈淋巴结转移是影响患者预后的重要因素,了解其颈淋巴结转移的规律,并对影响预后的淋巴结因素采取相应治疗措施,对提高口腔鳞癌治疗效果具有重要意义。     

Ras-p21,p53在阴茎癌腹股沟淋巴结中的表达及临床意义

Objective: The aim of this study was to investigate the expression and clinical significance of ras-p21 and p53 proteins in inguinal lymph nodes with penis carcinoma. Methods: The clinical data of 44 patients of penis (squamous) carcinoma and 40 non-tumor patients from 1990 to 2002 in our hospital were added to our research, 84 inguinal lymph nodes were got by lymph node biopsy from each patient at random. Pathological examination showed that 18 cases of cancer group were metastatic carcinoma as group A, th...     

Pre-tracheal lymph node metastasis in squamous cell carcinoma of the thoracic esophagus.

AIMS: To clarify the incidence of pre-tracheal lymph node metastasis in squamous cell carcinoma of the esophagus, and their impact on survival. METHODS: A cohort of 101 patients with squamous cell carcinoma of the thoracic esophagus who underwent esophagectomy together with 2-field lymphadenectomy including the pre-tracheal region was analysed, retrospectively. The p-TNM staging included stage I in 9, stage IIa in 33, stage IIb in 4, stage III in 43, and stage IV in 12 cases. RESULTS: Nodal metastases were identified in 56 patients (55.4%). Subcarinal lymph node and pre-tracheal lymph-node metastases were found in 24 patients (23.8%) and 15 patients (14.9%), respectively. The 5-year cumulative survival rates were 26.5 and 2.5% in nodal negative and nodal positive patients, respectively. Patients with pre-tracheal nodal metastasis all died within 2 years. Cox proportional hazards model in patients with nodal involvement revealed T-factor (p=0.0017), pre-tracheal nodal involvement (p=0.0055) and distant metastasis (p=0.0024) as independent prognostic factors. CONCLUSIONS: Our findings suggest that pre-tracheal lymph node metastasis indicates a dismal prognosis. Its occurrence is not unusual, especially in tumour of upper or middle thoracic esophagus. The subcarinal node cannot be regarded as a sentinel node of the pre-tracheal nodal station. Complete lymphadenectomy excluding the pre-tracheal lymph nodes in treating esophageal cancers is only a myth.     

临床病理参数对宫颈癌预后的影响

目的 探讨临床病理参数对宫颈鳞腺癌预后的影响。 方法 回顾性分析了702例宫颈癌患者,探讨了鳞腺癌组间构成差别,分别采用单因素和COX回归模型多因素分析了各自预后影响因素。 结果 在702例宫颈癌中,鳞癌630例,占89.4％,腺癌72例,占10.6％。与鳞癌相比,腺癌趋于年轻化、小体积、淋巴结转移,腺 癌5年生存率低于鳞癌(58.3％ VS 57.3％),但无统计学意义。多因素分析显示,组织分化、FIGO分期和淋巴结转移是鳞癌独立预后评价指标,而腺癌预后独立评价指标为FIGO分期和淋巴结转移。 结论 尽管宫颈鳞腺癌临床病理参数组间构成存在差异,但两者预后评价参数基本一样,即淋巴结转移和临床分期可能是评价两者最重要的临床、病理参数。