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。     

33例阴茎癌的外科治疗分析

目的:探讨阴茎癌合理的外科治疗方法。方法:回顾性分析2008年1月~2012年12月间收治的33例阴茎癌患者的临床资料:鳞状细胞癌患者31例,疣状癌患者2例。5例行阴茎局部病变切除术,26例行阴茎部分切除术,2例行阴茎全切加会阴部尿道造口术。行腹股沟淋巴结清扫术20例,其中7例行双侧改良根治性腹股沟淋巴结清扫术,10例行一侧改良根治性腹股沟淋巴结清扫术+对侧改良腹股沟淋巴结清扫术,3例行髂腹股沟淋巴结清扫术+对侧改良腹股沟淋巴结清扫术。结果:33例患者定期随访1~5年,平均随访31个月,1年生存率为93.9%(31/33),2年为87.9%(29/33),5年为72.7%(24/33)。本组6例T1G2期以上阴茎癌患者行预防性腹股沟淋巴结清扫术,术后随访生存率为83%(5/6);而另有14例未行腹股沟淋巴结清扫术,术后随访死亡7例,生存率为50%(7/14)。在33例阴茎癌患者中,9例可扪及单侧或双侧腹股沟淋巴结,行双侧淋巴结活检,有6例为阳性,阳性率高达66.7%(6/9);但有3例阴性患者随访过程中出现腹股沟淋巴结转移,假阴性率为13%(3/23)。有7例伴髂、腹股沟淋巴结转移,随访期间7例患者全部死亡,结论:对阴茎癌患者,合理地选择手术方式切除肿瘤,并合适地选择行腹股沟淋巴结清扫的时机和方式,采用一定的手术技巧,可明显提高患者生存率并减少并发症。     

阴茎癌51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51例阴茎癌患者的临床资料,其中鳞状细胞癌44例,鳞状上皮乳头状瘤恶变7例。均行手术治疗,其中行单纯肿瘤切除＋包皮环切术2例,阴茎部分切除术36例,阴茎全切＋尿道会阴部造口术13例,行双侧腹股沟淋巴结清扫术11例。结果41例获得随访,行阴茎部分切除术者2年和5年生存率分别为83．3％和76．7％,行阴茎全切除术者2年和5年生存率分别为72．7％和63．6％。结论阴茎癌早期诊断并予以手术为主的治疗对于改善患者预后十分重要,证实有淋巴结转移者应积极行髂腹股沟淋巴结清扫术。     

阴茎癌 215例临床分析

目的：探讨阴茎癌有效合理的治疗方法。方法：回顾性分析215你阴茎癌患者临床资料，211例行手术治疗，其中行阴茎部分切除术142例，阴茎全切除并尿道会阴部造口术69例，同时或二期行双侧腹股沟淋巴结清扫术64例。结果：146例获得随访。行阴茎部分切除术者5年和10年生存率分别为80.7%和64.4%。行阴茎全切除术是治疗Ⅰ、Ⅱ期阴茎癌十分合理和有效的方法，其生存率与阴茎全切除术无差别，阴茎癌预后与肿瘤分期密切相关。患者宜及早进行相应的手术治疗。     

阴茎癌84例临床分析

目的 寻求阴茎癌合理有效的治疗方法。方法 总结分析了阴茎癌84例,鳞状细胞癌80例,乳头状瘤恶变4例。行阴茎肿瘤局部切除3例,阴茎部分切除术67例,阴茎全切并尿道会阴部造口术14例,17例有癌转移者行腹股沟淋巴清扫术。结果 76例获得随访,行阴茎部分切除术者5年和8年以上生存率分别为88.5％和82.2％,行阴茎全切术者5年和8年生存率分别为81.8％和81.8％;二者比较无显著性差异(p>0.05)。无淋巴结转移者5年和8年生存率分别为88.3％和81.6％,有淋巴结转移者则分别为62.5％和50.0％,二者比较有显著性差异(p<0.05)。结论 包茎和包皮过长是导致阴茎癌的主要因素。合理选择适应症行阴茎部分切除术治疗有效,其5a和8a生存率较高,有淋巴结转移预后差。有明显转移者,应积极行腹股沟淋巴结清扫术。     

肿瘤分期,血管浸润和异形细胞占的比例:阴茎鳞状细胞癌发生腹股沟淋巴结转移的独立预测因素

股沟淋巴结转移是影响浸润性阴茎鳞状细胞癌患者预后的重要因素 ,早期腹股沟淋巴结清除术可提高生存率。体格检查、淋巴结穿刺细胞学检查假阳性率高 (2 5 % ) ,可靠方法是腹股沟淋巴结清除后病理检查。因此确定阴茎鳞状细胞癌发生腹股沟淋巴结转移的独立预测因素 ,选择高危阴茎鳞状细胞癌患者行治疗性腹股沟淋巴结清除术是重要的。材料和方法　 48例阴茎鳞状细胞癌患者 ,切除原发灶 ,行腹股沟淋巴结清除或严密随访 (平均随访 5 9个月 )。检查内容包括 :肿瘤病理分期 ,肿瘤大小 ,浸润深度 ,分级 ,在原发癌中异形细胞占的比例 ,有无血管浸润。…     

腹股沟淋巴结清扫术在阴茎癌治疗中的作用

目的:探讨腹股沟淋巴结清扫术在阴茎癌治疗中的作用,为临床治疗阴茎癌提供成功案例.方法:对15例阴茎癌而接受腹股沟淋巴结清扫术的患者进行临床治疗观察.结果:术后病理检查均发现13例有腹股沟淋巴结转移,2例有淋巴结增大,均诊断为鳞状细胞癌.结论:阴茎癌容易并发腹股沟淋巴结转移,建议常规行预防性腹股沟淋巴结清扫术,这有助于提高患者的生存率.     

阴茎鳞状细胞癌腹股沟淋巴结转移的危险因素分析

目的 探讨阴茎鳞状细胞癌腹股沟淋巴结转移的危险因素,筛选淋巴结转移的高危患者.方法 回顾性分析81例阴茎鳞状细胞癌患者临床及病理资料.年龄27～81岁,中位年龄49岁.病程＜1年者46例(56.8%),≥1年者35例(43.2%).行单侧腹股沟淋巴结清扫6例,双侧腹股沟淋巴结清扫75例.按2002年TNM分期标准进行分期,并记录患者年龄、有无包皮过长/包茎史、肿瘤部位、大小、数目、形状、分级、腹股沟淋巴结体格检查情况和淋巴结大小等指标.结果 81例患者中经病理证实有区域淋巴结转移者pN+42例(51.9%),无淋巴结转移者pN0 39例(48.1%).G1、G2、G3患者区域淋巴结转移发生率分别为32.0%(16/50)、78.3%(18/23)和100.0%(8/8),各组间比较差异有统计学意义(P=0.015).根据腹股沟淋巴结体格检查结果,cN+和cN0患者区域淋巴结转移发生率分别为63.5%(40/63)和11.1%(2/18),2组差异有统计学意义(P=0.012).81例均获随访,随访时间2～127个月,中位时间40个月.腹股沟淋巴结转移阳性患者与阴性患者的5年无病生存率分别为71.4%与92.3%(P=0.005),5年总生存率分别为79.0%与91.4%(P=0.001),差异均有统计学意义.结论 腹股沟淋巴结体格检查结果和肿瘤分级是腹股沟区域淋巴结转移的独立危险因素.腹股沟淋巴结转移患者5年无病生存率和总生存率较低,对淋巴结转移高危患者,应采取积极治疗措施.     

阴茎鳞状细胞癌腹股沟淋巴结转移的危险因素分析

目的 探讨阴茎鳞状细胞癌腹股沟淋巴结转移的危险因素,筛选淋巴结转移的高危患者.方法 回顾性分析81例阴茎鳞状细胞癌患者临床及病理资料.年龄27～81岁,中位年龄49岁.病程＜1年者46例(56.8%),≥1年者35例(43.2%).行单侧腹股沟淋巴结清扫6例,双侧腹股沟淋巴结清扫75例.按2002年TNM分期标准进行分期,并记录患者年龄、有无包皮过长/包茎史、肿瘤部位、大小、数目、形状、分级、腹股沟淋巴结体格检查情况和淋巴结大小等指标.结果 81例患者中经病理证实有区域淋巴结转移者pN+42例(51.9%),无淋巴结转移者pN0 39例(48.1%).G1、G2、G3患者区域淋巴结转移发生率分别为32.0%(16/50)、78.3%(18/23)和100.0%(8/8),各组间比较差异有统计学意义(P=0.015).根据腹股沟淋巴结体格检查结果,cN+和cN0患者区域淋巴结转移发生率分别为63.5%(40/63)和11.1%(2/18),2组差异有统计学意义(P=0.012).81例均获随访,随访时间2～127个月,中位时间40个月.腹股沟淋巴结转移阳性患者与阴性患者的5年无病生存率分别为71.4%与92.3%(P=0.005),5年总生存率分别为79.0%与91.4%(P=0.001),差异均有统计学意义.结论 腹股沟淋巴结体格检查结果和肿瘤分级是腹股沟区域淋巴结转移的独立危险因素.腹股沟淋巴结转移患者5年无病生存率和总生存率较低,对淋巴结转移高危患者,应采取积极治疗措施.     

腹股沟前哨淋巴结活检在阴茎癌治疗中的价值

目的 探讨腹股沟前哨淋巴结活检在阴茎癌手术治疗及二期髂腹股沟淋巴结清扫的意义. 方法 对阴茎癌患者在手术切除原发病灶的同时,行双侧腹股沟淋巴结活检,以确定其性质. 结果 46例阴茎癌患者中,高分化鳞癌25例,中分化鳞癌18例,低分化鳞癌3例.其中42例行前哨淋巴结活检,20例活检阳性,二期行髂腹股沟淋巴结清扫术;另22例阴性,其中淋巴结炎症及反应性增生者16例,密切观察随访. 结论 对阴茎癌患者手术切除原发病灶,同时作双侧腹股沟前哨淋巴结活检,对确定其有无转移及进一步对活检阳性者行髂腹股沟淋巴结清扫术具有重要的价值.     

Contemporary management of penile cancer including surgery and adjuvant radiotherapy: an experience in Taiwan

This retrospective study reports on the treatment outcomes of 45 men with penile cancer and seeks to address the issue concerning the treatment of inguinal lymph nodes (LN). Of these 45 patients, five had verrucous carcinoma and the other 40 had squamous cell carcinoma. Eighteen patients had inguinal lymph nodes (LNs) metastasis and received treatments of inguinal LNs involving bilateral inguinal LN dissection or unilateral inguinal LN dissection with or without postoperative radiotherapy. The median follow-up was 37 months. The ultimate local and regional controls for patients with verrucous carcinoma were 100 and 100%, respectively. Among the 40 patients with squamous cell carcinoma, the overall local control rate was 90%. The 5-year overall survival (OS) and disease-free survival (DFS) rates of patients without or with pathological inguinal LN metastasis were 70 vs. 22% (p=0.01), and 55 vs. 16% (p=0.004), respectively. The regional failure rates after inguinal LN dissection for pathological inguinal LN metastasis were 11% (1/9) and 60% (3/5) in patients with and without adjuvant radiotherapy. This study demonstrates that verrucous carcinoma shows excellent treatment outcomes following surgery alone. Squamous cell carcinoma of the penis is associated with a high incidence of inguinal lymph node metastasis. Elective groin dissection is indicated for all penile cancer patients except those with verrucous carcinoma and pT1 cancer with well-differentiated tumor. For patients with pathologically positive inguinal LN metastasis, adjuvant radiotherapy can increase inguinal control in this study. It warrants further prospective trial to prove the value of adjuvant radiotherapy in patients with pathological documented inguinal LN metastasis in penile cancer.     

Functional imaging in penile cancer: PET/computed tomography, MRI, and sentinel lymph node biopsy

PURPOSE OF REVIEW: The presence and extent of lymph node metastasis and primary tumor are among the most important prognostic factors in penile cancer. While inguinal lymphadenectomy is currently the most accurate means of staging, it is associated with severe morbidity and even mortality. Recent literature was reviewed for alternative means of staging. RECENT FINDINGS: Functional imaging modalities distinguish between inguinal lymph nodes with and without metastasis. The false-negative rate of dynamic sentinel lymph node biopsy has recently improved from approximately 20 to 5% in one study. In 13 patients with penile cancer, (18)F-fluorodeoxyglucose-PET/computed tomography was 80% sensitive and 100% specific for lymph node metastasis, but missed micro-metastasis. In seven patients with penile cancer, MRI with lymphotrophic nanoparticles was 100% sensitive and 97% specific for lymph node metastasis. SUMMARY: Combined PET/computed tomography and sentinel lymph node biopsy may help to detect both inguinal micrometastasis and pelvic and abdominal metastasis. Since MRI is highly accurate for staging of both primary penile cancer and its lymph node metastasis, however, it may turn out to be a powerful tool for a one-stop modality in the staging of penile cancer.     

Neoadjuvant and adjuvant chemotherapy with methotrexate, cisplatin and bleomycin for advanced penile cancer: a case report

A 58-year-old male consulted our hospital because of penile swelling and pain with bilateral inguinal lymphadenopathy. Pathological examination of the penile tumor and right superficial inguinal lymph node biopsy demonstrated moderately differentiated squamous cell carcinoma with lymph node metastasis. We diagnosed the tumor inoperable radically and adjuvant chemotherapy with methotrexate, cisplatin and bleomycin was administered, followed by partial penectomy and left superficial lymphadenectomy. The surgical specimens showed few viable tumor cells. This combination chemotherapy is suggested to be effective for the treatment of advanced penile cancer.     

Detection of inguinal lymph node involvement in penile squamous cell carcinoma by 18F-fluorodeoxyglucose PET/CT: A prospective single-center study

BackgroundThe extent of lymph node involvement is the most relevant prognostic factor in patients with penile cancer.ObjectiveTo prospectively analyze the diagnostic accuracy of 18F-FDG-PET/CT-scan in the assessment of inguinal lymph node involvement in patients with invasive penile carcinoma.Patients and methodsThirty-five patients with invasive penile carcinoma were staged prospectively by 18F-FDG-PET/CT-scan, and blindly evaluated by 2 nuclear medicine physicians. In total, lymph node involvement was assessed in 70 inguinal groins. Reference standard was either histology or clinical follow-up with a minimum of 31 months (mean: 48.4 months; range: 31–68 months).Results18-FDG-PET/CT showed a sensitivity of 88.2% and a specificity of 98.1%. Positive predictive value (PPV) was 93.8%, while negative predictive value (NPV) was 96.3%. In two groins, metastasis of 5 and 7 mm were missed by PET/CT scan.Conclusion18F-FDG-PET/CT is a promising staging tool in assessing the inguinal lymph node involvement of patients with penile carcinoma. Integration of PET/CT scanning into preoperative staging algorithms may avoid surgical staging in selected patients.     

亚甲蓝检测阴茎癌前哨淋巴结在腹股沟淋巴结清扫中的意义

目的:探讨亚甲蓝检测阴茎癌前哨淋巴结(SN)在腹股沟淋巴结清扫中的意义。方法:22例阴茎癌患者采取阴茎原发病灶切除同时,采用亚甲蓝检测腹股沟SN作活检,并选择SN转移病例及时行该侧腹股沟区淋巴结清扫术,计算该方法的准确度,假阴性率。结果:95%(21/22)的患者术中可检测到SN,19例患者两侧均可检测到SN,2例为单侧。21例患者中40枚SN,其中阳性淋巴结11例(27.5%)。4例腹股沟SN阴性患者在随访中出现腹股沟淋巴结或盆腔淋巴结转移。亚甲蓝在检查阴茎癌SN阳性预测率100%,准确度81%,其中假阴性率28%。结论:本方法术前准备简单,操作方便,费用较低,可作为一种经济有效的检测方式。     

Multimodality therapy in penile cancer: when and which treatments?

Objectives  Metastatic penile cancer typically comes to attention while the clinical extent of disease is limited to the inguinal or pelvic lymph nodes. Primary surgical management of lymph node metastases achieves tumor control and long-term survival for only a small percentage of these patients. To determine the optimal use of multimodality treatment in locally advanced penile cancer, we conducted a literature review. Methods  Relevant English-language literature was identified with the use of Medline; additional cited works not detected on the initial search were also reviewed. Results  There is an emerging strategy of preoperative (neoadjuvant) combination chemotherapy to improve the progression-free survival of penile cancer patients with bulky regional lymph node metastases. Radiotherapy for inguinal metastases and postoperative (adjuvant) radiation for selected patients has also been effective in this setting. Conclusions  In patients with lymph node metastases, the benefit of ilioinguinal lymphadenectomy may be extended by the addition of neoadjuvant chemotherapy. Postoperative radiotherapy can be offered depending on the amount of residual disease after chemotherapy. Chemo-radiotherapy has been successful in squamous cell cancers from other sites (vulva and anal canal) and may be considered for unresectable penile cancer.     

Current practice patterns of society of urologic oncology members in performing inguinal lymph node staging/therapy for penile cancer: A survey study

ObjectivesInguinal lymph node (ILN) staging and therapeutic procedures are important for the diagnosis and management of suspected Inguinal lymph node metastasis in the setting of penile cancer. Morbidity associated with inguinal lymph node dissection (ILND) and the lack of standardization in its perioperative management are both significant. In this study, we aimed to define current management approaches and potential opportunities for improving outcomes.Methods and materialsA questionnaire was developed with 16 questions regarding pre, peri, and postoperative management of patients undergoing ILND. The questionnaire was approved by the Society of Urologic Oncology (SUO) Questionnaire Committee, which facilitated its dissemination through an initial email and a follow-up reminder to 1,003 members. The study was conducted from July to August, 2020.ResultsOf the 1,003 SUO members invited to participate, 93 responded (9.3% response rate); 49% performed 1 to 2 ILNDs annually, and 60% chose open ILND for high-risk primary cancer cN0. For suspicious lymph nodes > 2 cm, 69% preferred ILND, 86% preoperative systemic neoadjuvant chemotherapy, followed by surgery for bulky inguinal metastasis, and 84% used perioperative antibiotics (ABX), 53% of whom discontinued ABX 24 hours after surgery. Prophylactic anticoagulation was used by 78% of respondents, and 60% stopped it after ambulation. Specific ligation of lymphatics (versus none) was used by 82% of respondents, 55% obtained frozen sections, and 94% used inguinal drains. A saphenous sparing technique was used by 75% of respondents. An incisional wound vacuum device was used by 17% of respondents. Compression stockings and/or referral to a lymphedema specialist were used to manage postoperative lymphedema by 61% of respondents.ConclusionsResponses to a penile lymphadenectomy survey were relatively low and were primarily from the academic surgeon subset of the SUO. Significant consensus ( ≥ 70%) was noted for neoadjuvant chemotherapy for bulky nodal metastasis prior to surgery, perioperative antibiotic use, ligation of lymphatics, drain placement, and saphenous sparing dissection techniques. Other evidenced-based strategies that could decrease morbidity were rarely used, including dynamic sentinel node biopsy, incisional wound vacuums, and lymphedema prevention. Prospective trials are needed to validate and resolve existing treatment paradigms and to optimize perioperative pathways to reduce complications in penile cancer management.