阴茎癌原发灶术后即刻腹股沟淋巴结清扫对患者生存的影响

Immediate Inguinal Lymph Node Dissection Improves Survival in Patients of Penile Cancer

目的探讨阴茎癌原发灶术后即刻腹股沟淋巴结清扫对患者生存预后的影响。方法收集2008年12月至2014年4月于四川大学华西医院行腹股沟淋巴结即刻或延迟清扫术的67例阴茎癌患者的临床病理及随访资料。所有患者原发病灶术后均无可查见的长大腹股沟淋巴结,33例在术后1月内行腹股沟淋巴结预防性切除为即刻清扫;34例待出现可查见的长大淋巴结行治疗性切除为延迟清扫。Kaplan-Meire生存分析并比较两组间的差异。对数秩检验分析各临床病理因素对患者生存的影响,包括年龄、原发肿瘤形态、大小、位置,肿瘤分期、分级,淋巴结病理分期,原发灶手术至淋巴结清扫术间隔时间长短、清扫术前有无长大的腹股沟淋巴结等。Cox回归分析影响患者清扫后生存预后的独立因素。结果 67例患者年龄26~84岁,中位年龄为50岁。随访时间3~76月,中位随访时间23月。患者总的3年生存率和5年生存率分别为70.1%和65.4%。即刻清扫组中位随访时间为31月,5年生存率为93.1%,其中腹股沟淋巴结病理阳性者7例（21.25%）;延迟清扫组中位随访时间为11.5月,5年生存率为33.7%,其中腹股沟淋巴结阳性者26例（76.5%）。单因素分析显示：肿瘤分期、分级,清扫术前腹股沟淋巴结有无长大、淋巴结病理分期均为影响患者生存的因素。Cox回归分析显示：清扫术前是否有可查见的长大淋巴结是影响患者生存的独立因素。待扪及腹股沟淋巴结长大再行淋巴结清扫,其死亡危险度增加。结论腹股沟淋巴结长大是影响阴茎癌患者生存的重要因素,阴茎癌原发病灶术后行即刻腹股沟淋巴结清扫可有效改善患者的预后。

Objective To investigate the clinical outcome of immediate inguinal lymph node dissection on the survival of the patients with penile carcinoma.Methods A total of 67 patients of penile carcinoma whose inguinal lymph nodes（ILN）were initial clinically impalpable,received inguinal lymph node dissection（ILND）from Dec2008 to April 2014.Among them,33 patients received immediate ILND within 1month after the resection of penile cancer,while 34 patients underwent delayed ILND which was performed when ILN was found clinically apparent during follow-up.The Kaplan-Meier survival analysis was performed.The prognostic factors was evaluated by logrank test,including age,morphology,location,T stage,grade of primary tumor,clinical status of ILN before ILND,lymphatic pathology,time to ILND.Cox proportional hazard model was used to find the independent risk factors on survival.Results The median age was 50year-old（range 26 to 84year-old）.The median follow-up time was 23months（range 3-76months）.The 3-year and 5-year overall survival were 70.1% and 65.4%,respectively,The 5-year survival rate in immediate ILND and delayed ILND group were 93.1%,and 33.7% respectively.Positive ILN metastasis was found in 7patients from immediate ILND group but 26 patients from delayed ILND group.that the prognostic factors included T stage,tumor grade,clinical status of inguinal lymph nodes before ILND,and lymphatic pathology.Cox model found the status of inguinal lymph nodes was independent prognostic factor for the survival.Conclusion Inguinal lymph node metastasis is the important prognostic indicator of the survival of penile cancer.Immediate ILND could improve survival for the patients with clinically impalpable lymph nodes.