58例阴茎鳞状细胞癌治疗的临床分析

目的:提高阴茎鳞状细胞癌的治疗水平,寻求鳞状细胞癌合理有效的治疗方法。方法:回顾分析58例病理活检证实阴茎鳞状细胞癌治疗的临床资料。结果:按照Jackson分期,Ⅰ期25例,Ⅱ期18例,Ⅲ期11例,Ⅳ期4例。53例行手术治疗;行阴茎肿瘤局部切除及阴茎癌部分切除43例;阴茎全切除并尿道会阴部造口术及髂腹股沟淋巴清扫术10例(腹股沟淋巴结均阳性,髂淋巴结阳性1例)。术前新辅助治疗(热疗加化疗)联合术后化疗37例,仅术后化疗12例,单纯手术治疗4例;5例未手术治疗患者行化疗和/或放疗。48例随访2~5年,4例行阴茎部分切除者2年内复发,4例2年内死亡,7例2~5年内死亡,2年生存率为91.7%,5年生存率为77.1%,10例失访或随访期未满2~5年。结论:外科手术治疗、术前新辅助治疗联合术后化疗是目前治疗阴茎鳞状细胞癌的有效方法,淋巴结的清扫根据临床分级具体处理,手术联合术前新辅助治疗及术后化、放疗是否可减少复发及提高生存率,还需进一步研究。

Treatment of 58 cases of penile squamous cell carcinoma

Objective:To search for rational and effective treatments for penile squamous cell carcinoma(PSCC).Methods:We retrospectively analyzed the clinical data of 58 cases of pathologically confirmed PSCC,focusing on the treatment methods.Results:Based on Jackson Staging,25 of the 58 cases fell into stage Ⅰ,18 stage Ⅱ,11 stage Ⅲ,and 4 stage Ⅳ.Fifty-three of the patients were treated by surgery,of whom 43 underwent limited resection of the tumor or partial amputation of the penis,and the other 10 received total penis amputation plus perineal urethrostomy and clearance of lymphoglandulae iliacae and inguinal lymph nodes,with the lymphoglandulae iliacae positive in 1 case and the inguinal lymph nodes positive in all.Thirty-seven cases received neoadjuvant hormonal therapy(thermotherapy plus chemotherapy) and combined postoperative chemotherapy,12 postoperative chemotherapy only,and 4 merely surgery.Five of the total number underwent chemotherapy and/or radiotherapy without surgery.The 2-5 years follow-up of 48 patients found recurrence in 4 cases of partial penis amputation within 2 years,4 deaths within 2 years,7 deaths from 2 to 5 years.The 2-and 5-year survival rates were 91.7% and 77.1%,respectively.Ten of the cases were lost in follow-up.Conclusion:Surgery + neoadjuvant hormonal therapy + postoperative chemotherapy and/or radiotherapy is an effective method for PSCC,but whether it can reduce the recurrence of PSCC and improve the survival of the patients remains to be further studied.Natl J Androl,2010,16(9):822-825