362例阴茎癌患者临床病理特征及预后分析

The clinicopathological features and prognosis of 362 patients with penile carcinoma

目的探讨阴茎癌患者的临床病理特征及预后情况。方法回顾性分析2005年1月至2020年12月于复旦大学附属肿瘤医院手术治疗的362例阴茎癌患者的临床资料。患者年龄(57.0±0.7)岁。临床N分期N_(0)期239例,N_(1)期57例,N_(2)期37例,N_(3)期29例;所有患者均未出现远处转移。根据肿瘤直径及位置,50例行扩大包皮切除术,283例行阴茎部分切除术,29例行阴茎全切术。183例行腹股沟淋巴结清扫术,47例行盆腔淋巴结清扫术。分析肿瘤病理类型、肿瘤直径、HPV病毒亚型、术后病理分期、总体生存率(OS)及预后。采用Kaplan-Meier法进行生存分析,采用多因素Cox回归分析影响阴茎癌患者生存的危险因素,并计算患者5年OS。结果术后病理分期:T_(1a)期137例,T_(1b)期24例,T_(2)期51例,T_(3)期136例,T_(4)期14例;N_(0)期235例,N_(1)期54例,N_(2)期31例,N_(3)期42例。病理类型:鳞状上皮癌300例,疣状癌40例,肉瘤样癌7例,原位癌6例,基底样癌6例,腺鳞癌3例。最常见的细胞分化类型为高分化(160例,44%),其次为中分化(130例,36%);低分化46例(13%),未判定分化类型26例。135例肿瘤直径<3cm,142例肿瘤直径≥3cm,85例肿瘤直径未明确。173例(48%)HPV阳性,189例(52%)HPV阴性。362例术后随访(43.9±1.4)个月,79例随访过程中因肿瘤广泛转移而死亡。Kaplan-Meier生存分析结果显示,HPV阳性患者的5年OS高于HPV阴性患者(79%与72%),差异无统计学意义(P=0.09)。原发灶肿瘤直径≥3cm(142例)患者的5年0S低于肿瘤直径<3cm(135例)患者(69%与85%),差异有统计学意义(P=0.02)。高、中、低分化患者的5年0S分别为85%、70%、58%,三组差异有统计学意义(P<0.01)。病理分期T_(1a)、T_(1b)、T_(2)、T_(3)、T_(4)期患者的5年0S分别为90%、67%、71%、68%、37%(P<0.01);其中,T_(1a)、T_(1b)、T_(2)期患者5年0S的差异有统计学意义(P=0.003)。N_(0)、N_(1)、N_(2)、N_(3)期患者的5年0S分别为91%、62%、57%、30%(P<0.01);患者N分期越高,预后越差。24例T_(1b)期患者中7例未行腹股沟淋巴结清扫,17例行腹股沟淋巴结清扫;T_(1b)期清扫淋巴结、T_(1b)期未清扫淋巴结及T_(2)期患者的5年0S分别为73%、57%、71%(P=0.22)。多因素Cox回归分析结果显示,N分期(HR=4.55,95%CI2.64~7.85,P<0.01)和肿瘤分化程度(HR=2.09,95%CI1.09~4.02,P=0.03)是影响患者术后生存的独立危险因素。结论N分期及肿瘤细胞分化程度是影响患者术后生存的独立危险因素;肿瘤细胞分化越差,患者预后越差。腹股沟淋巴结清扫手术能改善T期阴茎癌患者预后。

Objective To investigate the clinicopathological features and prognosis of patients with penile cancer.Methods The clinical data of 362 patients with penile cancer who underwent surgery in Fudan University Shanghai Cancer Center from January 2005 to December 2020 were retrospectively analyzed.The mean age was(57.0±0.7)years.According to the clinical N stage classification,239 patients were in N_(0) stage,57 patients in N_(1) stage,37 patients in N_(2) stage,and 29 patients in N_(3) stage.All these patients had no metastasis.Based on tumor size and location,50 patients underwent extended circumcision,283 patients underwent partial penectomy,and 29 patients underwent total penectomy.One hundred and eighty-three patients underwent inguinal lymphadenectomy and 47 patients underwent pelvic lymphadenectomy.Tumor pathology,tumor size,HPV subtype,postoperative pathological stage,overall survival(OS)and prognosis were analyzed.The Kaplan-Meier analysis and multivariate Cox regression analysis were used to analyse the factors which could affect the survival of patients.5-year OS rate of these patients were also calculated.Results In the pathological T classification,137 cases were in T_(1a) stage,24 cases in T_(1b) stage,51 cases in T_(2) stage,136 cases in T_(3) stage,and 14 cases in T4 stage.In the pathological N classification,235 cases were in N_(0) stage,54 cases in N_(1) stage,31 cases in N_(2) stage and 42 cases in N_(3) stage.The most common tumor type was squamous cell carcinoma(300 cases,83%),followed by verrucous carcinoma(40 cases,11%),sarcomatoid carcinoma(7 cases),carcinoma in situ(6 cases),basal-like carcinoma(6 cases),and adenosquamous carcinoma(3 cases).The most common tumor grade was mild(160 cases,44%),followed by moderate differentiation(130 cases,36%),poor differentiation(46 cases,13%),and unclear differentiation(26 cases).The tumor sizes were<3 cm in 135 patients and≥3 cm in 142 patients.The tumor size was unclear in 85 patients.173 cases(48%)were HPV positive and 189 cases(52%)were HPV negative.The Kaplan-Meier analysis showed the 5-year OS rate of HPV-positive group was higher than that of HPV-negative group(79%vs.72%)but no significant difference was found(P=0.09).The 5-year 0S rate of patients whose tumor≥3 cm(69%)was lower than those tumor<3 cm(85%)and significant difference could be found(P=0.02).The 5-year 0S rate of wild and moderate and poor grade were 85%,70% and 58%,and significant difference could be found in the three groups(P<0.O1).The 5-year OS rates of patients with stage T_(1a),T_(1b),T_(2),T_(3) and T4 were 90%,67%,71%,68% and 37% respectively(P<0.01).The 5-year 0S rates of patients with stage N_(0),N_(1),N_(2),and N_(3) were 91%,62%,57%,and 30%,respectively(P<0.01).N stage could significantly affect the prognosis.The 5-year OS rate of Tib patients was lower than that of T_(1a) and T_(2) stage(67%vs.90%vs.71%,P=0.003).0f the 24 patients with Tib stage,17 cases received inguinal lymphadenectomy and 7 cases not.The 5-year OS rate of Tin,who received lymphadenectomy,who not and T_(2) group were 73%,57% and 71% respectively(P=0.22).Multivariate Cox analysis showed that N stage(HR=4.55,95%CI 2.64-7.85,P<0.01)and tumor grade(HR=2.09,95%CI 1.09-4.02,P=O.03)were independent factors which could affect the prognosis.Conclusions N stage and tumor grade were independent factors which could affect the prognosis.The poorer the tumor grade,the worse the prognosis.Inguinal lymphadenectomy could improve the prognosis of patients with T_(1b) stage.