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

Prognostic value of bilateral inguinal lymph node metastases in node-positive penile cancer

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。

Objective To evaluate the prognostic value of bilateral inguinal lymph node metastases in node-positive penile cancer. Methods Sixty patients with surgically resected node-positive penile cancer were analyzed. All the patients underwent regional lymph node dissection. Recurrence free survival curves were plotted by Kaplan-Meier method and compared by the Log-rank test. Multivariate survival analysis was performed using Cox regression model. Results Of all the patients, 18 cases had bilateral inguinal lymph node metastases. The 3-year recurrence free survival rate in patients with bilateral invovlement was significantly lower than those with unilateral disease （26.7 % vs 65.3 %, X^2 =10.6, P =0.001）. In order to evaluate wether the prognostic significance of bilateral lymph node metastases was dependent of increased number of positive nodes, the two predictors were included in multivariate survival analysis. Both the number of metastatic nodes and bilateral nodal disease were independent prognostic factors （P 〈0.05）. Comparisons of survival curves showed those patients with bilateral nodal disease and more than 2 metastatic nodes had worst outcome. Conclusion Bilateral inguinal lymph node metastases is an important prognostic factor in penile cancer irrespective of the number of positive lymph node.