阴茎鳞状细胞癌淋巴结清扫术后复发类型及预后因素分析

目的 评估阴茎癌原发灶切除术及标准淋巴结清扫术后复发类型和影响预后的可能因素. 方法 回顾性分析1990 -2005年73例阴茎鳞状细胞癌患者资料.阴茎部分切除62例,阴茎全切11例.73例均接受区域淋巴结清扫.随访时间16 ～183个月,平均32个月.免疫组化法检测肿瘤细胞p53和Ki-67的表达水平.统计学分析患者复发类型、病理特征及预后. 结果 患者术后肿瘤复发20例(27.4％),复发时间为术后6 ～ 17个月,平均11个月,其中3例在末次随访时仍存活.复发患者的肿瘤特异性生存时间为16 ～83个月,平均26个月.远处及多处复发为高级别肿瘤的常见复发类型(P =0.017).单因素分析显示肿瘤分期、病理分级、淋巴结转移、淋巴结外累及和p53蛋白表达水平与3年无病生存率降低密切相关.多因素分析显示只有病理分级(P =0.025)和淋巴结状态(P =0.024)是无病生存率的独立预后因素. 结论 病理分级和淋巴结状态是阴茎癌无病生存率的独立预后因素,高级别肿瘤易发生远处及多处复发.

Patterns of recurrence and prognostic factors of disease free survival in penile squamous cell carcinoma treated with lymphadenectomy

Objective To evaluate the recurrence patterns and possible prognostic factors in primary penile cancer treated with penectomy and standard lymphadenectomy.Methods The records of 73 patients with penile squamous cell carcinoma who underwent penile amputation and regional lymphadenectomy between 1990 and 2005 were reviewed.The median follow up was 32 ( 16 - 183) months.Molecular markers including p53 and Ki-67 were detected using immunohistochemistry.Recurrence patterns,pathological characteristics,and patient outcomes were analyzed.Results Twenty( 27.4％ ) patients developed recurrences at a mean of 11 (6 - 17 ) months postoperatively and 3 cases remained alive at last follow-up.The mean cancer specific survival of the recurrent patients was 26 ( 16 - 83 ) months.Distant metastasis and multiple recurrences were common among patients with high-grade tumor (P =0.017 ).Univariate analysis revealed that higher primary tumor stage,higher pathological grade,lymph node metastasis,extra-nodal involvement and positive p53 protein expression were significantly associated with decreased 3-year disease free survival rates.Cox regression identified that only pathological grade ( P =0.025 ) and lymph node status ( P =0.024 ) were independent predictors of disease free survival.Conclusions Pathological grade and lymph node status were independent predictors of disease free survival in patients with penile squamous cell carcinoma in this cohort.Patients with high-grade disease are likely to recur in a distant or multiple pattern.