淋巴结外侵犯程度是影响阴茎癌患者预后的重要预测因子

The extent of extranodal extension is a significant prognostic factor for patients with pathological extran- odal extension penile carcinoma

目的探讨淋巴结外侵犯(extranodal extension,ENE)对阴茎癌患者生存的影响,并对可能影响ENE的患者生存预后的因子进行分析。方法回顾31例行腹股沟淋巴结清扫术且病理证实ENE的阴茎癌患者资料,所有患者术前未行辅助治疗,术后均给予辅助放疗。应用显徽标尺测量淋巴结包膜至肿瘤外侵的最大距离,如果肿瘤破坏淋巴结包膜≥1/3,则认为该患者ENE距离不可测量。研究终点为总体生存期,生存分析数据采用Kaplan-Meier法进行计算,并用Log-rank法对生存率进行比较,进一步对有意义的因子行Cox模型多因素回归分析。结果腹股沟淋巴结转移的患者中ENE的发生率为51.8%。ENE患者中位总体生存期为18个月(95%CI 14.4～21.6个月),5年生存率为23%。ENE淋巴结数目≥3、ENE不可测量以及盆腔淋巴结转移对此类患者预后的影响有统计学意义。多因素分析显示仅ENE不可测量(HR:4.24)对总体生存期有统计学意义。结论阴茎癌伴有腹股沟ENE时5年生存率较差,ENE距离是影响此类患者总体生存期的重要因子,当ENE距离不可测量时,患者的中位生存期仅为7.5个月。

Objective To assess the prognostic significance of the extent of extranodal exten- sion （ENE）, as well as several other risk factors in pathological ENE penile carcinoma cases. Methods We retrospectively analyzed the data on a consecutive series of 31 chemotherapy naive pa- tients with proven ENE who underwent therapeutic regional lymphadenectomy. Postoperative eternal radiotherapy was undergone. The maximum distance from the external capsular border to the far- thest extent with tumor involvement was measured, the distance couldnPt be measured when the cap- sular was destroyed more than 1/3. We estimated overall survival （OS） using the Kaplan-Meier method. Multivariate analysis was done according to the Cox proportional hazards model of factors statistically significant on univariate analysis. Results The incidence of ENE was 51.80% in pa- tients with pathological node positive penile carcinoma. The median OS and 5-year survival was 18 months （95% CI 14. 4-21.6） and 23%, respectively. Prognostic variables on univariate analysis were ENE ≥ 3, the extent of ENE hard to be measured and plevic lymph node involvement. On multivariate analysis only the extent of ENE remained associated with decreased overall survival （HR..4.24）. Conclusions The extent of ENE hard to be measured is an independent predictive factor of overall survival in patients with pathologically extranodal extension penile carcinoma.