阴茎癌改良pN2分期预后意义分析

Modified pathological N_2 staging system in prognosis predicting of penile cancer patients

目的：将国际抗癌协会一美国肿瘤联合委员会（UnionforInternationalCancerControl-AmericanJointCommitteeonCancer，UICC-AJCC）第7版阴茎癌病理N2（pN2）期分为pN2a期（单侧多发腹股沟淋巴结结内转移）和pN2b期（双侧腹股沟淋巴结结内转移），探讨阴茎癌改良pN2分期的预后意义。方法：回顾分析中山大学肿瘤防治中心2002-12-01-2012-06-30收治的153例阴茎癌患者资料。将pN2期患者，按照腹股沟淋巴结转移侧数分为pNza和pN2b两组，分析pN2a和pN2b期患者的临床病理特点及与预后关系。Kaplan-Meier法进行疾病特异性生存率（diseasespecificsurrival，DSS）分析并采用Log-rank检验进行比较。Logistic回归分析评价第7版pN分期和改良pN分期系统比较。采用x2值、AIc标准和c-index一致性系数比较预测预后准确度。结果：71例患者病理确诊腹股沟淋巴结转移并纳入研究。清除淋巴结中位数为22（5～53）个，其中阳性淋巴结中位数3（1～16）个。pNl患者21例（29．6％），3年DSS为94．4％；pN2患者33例（46．5％），3年DSS为69．6％；pN3患者17例（23．9％），3年DSS为27．2％。按照改良的病理N2分期标准，pN2。期的3年DSS为84．7％（19例）；pN2b期的3年DSS为50．1％（14例），两组之间的DSS差异有统计学意义，p=0．034。计入淋巴结转移侧数的阴茎癌改良病理N2分期系统在预测预后方面的准确性显著增加。结论：阴茎癌改良pN2分期较第7版阴茎癌pN2分期能更好地预测疾病特异生存率，但尚需外部资料验证以进一步明确其有效性。

OBJECTIVE：To determined whether the pathological Nz staging system of Union for International Cancer Control-American Joint Committee on Cancer（UICC-AJCC）, which divided into pN2a and pN2b ,leads to more specific pre diction of survival for patients with penile cancer. METHODS：The case records of 153 patients with penile cancer who un derwent inguinal lymphadenectomy between 2002 and 2012 were analyzed, pN2 patients were divided into 2 groups and they were multiple inguinal lymph nodes metastasis group and bilateral inguinal lymph nodes metastasis group,according to pathological information on the lymph node metastasis laterality. The survival was analyzed by Kaplan-Meier and Log- rank test. Predictive accuracy was assessed by Logistic and the criteria was investigated to evaluate the prognostic models with chi-square,AIC and the Harrell c-index. RESULTS： Totally 71 patients were proved to be lymph node metastasis. The median number of LNs removed was 22 （range 5-53 nodes）. There were 21（29.6%）,33（46.5%）,17（23.9%） patients exhibited pNt ,pN2 ,pN3 ,respectively. The 3-year disease specific survival （DSS） was 94.4% ,69.6%,27.2% for pN1 ,pN2 and pNa disease respectively. In this group of patients,19（57.6%） had pN2a disease,and 14（42.4%） had pN2h disease. The 3-year DSS for pN2a, pN2b disease was 84.7 % and 50.1 %, respectively. Better survival stratification was ob- served on analysis （P=0. 034）. Adding lymph node metastasis laterality significantly increased the accuracy of the patho logical 7th N2 category to improve prognostication and predict cancer specific survival. CONCLUSIONS：The modified pathological N2 staging system is proved to be a significantly better prognosticator of DSS than the current pathological N2 staging system in patients with penile cancer. Further independent validation is required to determine the clinical useful ness of new pathological N staging system in these patients.