阴茎鳞状细胞癌预后因素的分析

Prognostic factors in penile squamous cell carcinoma

目的:探讨影响阴茎鳞状细胞癌(penile squamous cell carcinoma,PSCC)预后的因素,并对影响PSCC患者预后的危险因素进行分析。方法:回顾性分析106例确诊为PSCC患者的临床资料,去找出影响预后的因素。考虑的因素包括T分期、组织学分级、浸润深度、淋巴管/血管的浸润、阴茎海绵体的浸润、尿道海绵体的浸润、尿道的浸润和腹股沟淋巴结转移。运用Kaplan-Meier法初步筛选出预后因素,再运用Cox回归模型进行多因素分析这些筛选出的预后因素与预后的关系。结果:101例获随访,随访率95.3%,随访8~86个月,中位随访53个月,死亡39例,其中死于肿瘤32例。Kaplan-Meier单因素生存分析T分期(P<0.05)、组织学分级(P=0.006)、肿瘤浸润深度(P=0.005)、肿瘤浸润淋巴管/血管(P<0.05)、肿瘤浸润尿道海绵体(P<0.05)、肿瘤浸润尿道(P<0.05)、腹股沟淋巴结转移(P<0.05)与PSCC预后密切相关;Cox多因素生存分析只有组织学分级(P=0.009)、肿瘤浸润淋巴管/血管(P=0.006)、腹股沟淋巴结转移(P<0.05)差异有统计学意义。结论:肿瘤组织学分级、肿瘤浸润淋巴管/血管、腹股沟淋巴结转移是PSCC预后独立预测因素。

Objective:To evaluate prognostic factors in penile squamous cell carcinoma(PSCC)and analyze the risk factors influencing prognosis of PSCC.Methods:The clinical data of 106patients with PSCC who under-went surgical treatment were retrospectively reviewed to identify prognostic factors.Eight variables including T stage,histological grade,invasion depth,lymphovascular invasion,infiltration of the corpus cavernosum penis or corpora cavernosum urethrae,urethral infiltration and inguinal lymph node metastasis.Univariate analysis of Kap-lan-Meier was chosen for multivariate logistic regression analysis.Results:One hundred and one(95.3%)patients were followed up,and the median follow-up time was 53(range,8-86)months.Thirty-nine patients died,and among them 32died of cancer.Variables which were significantly associated with prognosis on Kaplan-Meier anal-ysis were T stage(P<0.05),histological grade(P=0.006),invasion depth(P=0.005),lymphovascular inva-sion(P<0.05),corpora cavernosa infiltration(P<0.05),urethral infiltration(P<0.05)and inguinal lymph node metastasis(P<0.05).Multivariate logistic regression analysis showed that histological grade(P=0.009),lymphovascular invasion(P=0.006)and inguinal lymph node metastasis(P<0.05)were significantly associated with prognosis.Conclusion:Histological grade,lymphovascular invasion and inguinal lymph node metastasis were independent risk factors for prognosis of PSCC.