建立预测阴茎鳞状细胞癌区域淋巴结转移风险的列线图

Construction of a nomogram predicting the risk of regional lymph node metastases in penile squamous cell carcinoma

目的根据阴茎癌原发灶的病理指标，建立预测阴茎鳞状细胞癌区域淋巴结转移风险的列线图。方法收集1990—2005年73例阴茎鳞状细胞癌患者资料，患者均接受阴茎肿瘤切除和区域淋巴结清扫术。免疫组化法检测分子指标（p53、Ki67、E-cadherin和MMP-9）的表达水平。采用Logistic回归模型建立列线图。预测淋巴结转移的变量包括年龄、分期、分级、蛋白表达水平（p53、Ki67、E—cadherin和MMP-9）和脉管侵犯。其中年龄为连续变量，分期、分级、蛋白表达水平和脉管侵犯为分类变量。结果肿瘤分级、p53表达水平和脉管侵犯是预测区域淋巴结转移的独立预后因素（P〈0．05），回归系数分别为3．97、2．12和2．37，OR值分别为52．99、8．33和10．70。用于预测淋巴结转移风险的列线图显示出良好的一致系数（0．92）和良好的校准。结论基于阴茎鳞状细胞癌原发灶的病理特征，构建预测区域淋巴结转移风险的列线图，不仅有助于个体化的判断肿瘤转移的风险，并且有助于与患者的交流和治疗选择。

Objective To construct and evaluate a nomogram for predicting the risk of regional lymph node metastases according to pathological features of the primary penile squamous cell carcinoma. Methods The clinical and pathological data of 73 patients who had undergone partial/radical penectomy and ilio/inguinal lymphadenectomy for squamous cell carcinoma of the penis from 1990 to 2005 were retrospectively collected. The expressions of molecular markers （p53, Ki-67, E-cadherin and MMP-9） were determined by immunohistochemistry. A logistic regression model was used to construct the nomogram. Results Tumor grade, the expression level of p53 and lymphovascular invasion were independent prognostic factors of regional lymph node involvement（P^0.05）. The nomo- gram predicting the risk of metastatic lymph node involvement showed a good concordance index （0.92） and good calibration. Conclusions Based on the pathological findings of primary tumor, a nomogram to predict the probability of regional lymph node involvement in penile squamous cell carcinoma patients is constructed. This statistical tool is not only helpful in judging individualizing tumor risk, but also in facilitating patient＇s communication in treatment options.