CAJ | 학술논문

目的探讨阴茎鳞状细胞癌腹股沟淋巴结转移的危险因素,筛选淋巴结转移的高危患者.方法回顾性分析81例阴茎鳞状细胞癌患者临床及病理资料.年龄27～81岁,中位年龄49岁.病程＜1年者46例(56.8%),≥1年者35例(43.2%).行单侧腹股沟淋巴结清扫6例,双侧腹股沟淋巴结清扫75例.按2002年TNM分期标准进行分期,并记录患者年龄、有无包皮过长/包茎史、肿瘤部位、大小、数目、形状、分级、腹股沟淋巴结体格检查情况和淋巴结大小等指标.结果 81例患者中经病理证实有区域淋巴结转移者pN+42例(51.9%),无淋巴结转移者pN0 39例(48.1%).G1、G2、G3患者区域淋巴结转移发生率分别为32.0%(16/50)、78.3%(18/23)和100.0%(8/8),各组间比较差异有统计学意义(P=0.015).根据腹股沟淋巴结体格检查结果,cN+和cN0患者区域淋巴结转移发生率分别为63.5%(40/63)和11.1%(2/18),2组差异有统计学意义(P=0.012).81例均获随访,随访时间2～127个月,中位时间40个月.腹股沟淋巴结转移阳性患者与阴性患者的5年无病生存率分别为71.4%与92.3%(P=0.005),5年总生存率分别为79.0%与91.4%(P=0.001),差异均有统计学意义.结论腹股沟淋巴结体格检查结果和肿瘤分级是腹股沟区域淋巴结转移的独立危险因素.腹股沟淋巴结转移患者5年无病生存率和总生存率较低,对淋巴结转移高危患者,应采取积极治疗措施.
목적 탐토음경린상세포암복고구림파결전이적위험인소,사선림파결전이적고위환자.방법 회고성분석81례음경린상세포암환자림상급병리자료.년령27～81세,중위년령49세.병정＜1년자46례(56.8%),≥1년자35례(43.2%).행단측복고구림파결청소6례,쌍측복고구림파결청소75례.안2002년TNM분기표준진행분기,병기록환자년령、유무포피과장/포경사、종류부위、대소、수목、형상、분급、복고구림파결체격검사정황화림파결대소등지표.결과 81례환자중경병리증실유구역림파결전이자pN+42례(51.9%),무림파결전이자pN0 39례(48.1%).G1、G2、G3환자구역림파결전이발생솔분별위32.0%(16/50)、78.3%(18/23)화100.0%(8/8),각조간비교차이유통계학의의(P=0.015).근거복고구림파결체격검사결과,cN+화cN0환자구역림파결전이발생솔분별위63.5%(40/63)화11.1%(2/18),2조차이유통계학의의(P=0.012).81례균획수방,수방시간2～127개월,중위시간40개월.복고구림파결전이양성환자여음성환자적5년무병생존솔분별위71.4%여92.3%(P=0.005),5년총생존솔분별위79.0%여91.4%(P=0.001),차이균유통계학의의.결론 복고구림파결체격검사결과화종류분급시복고구구역림파결전이적독립위험인소.복고구림파결전이환자5년무병생존솔화총생존솔교저,대림파결전이고위환자,응채취적겁치료조시.
Objective To explore the risk factors of inguinal metastasis in squamous cell carcinoma of the penis, screening lymph node metastasis high-risk patients. Methods The clinical and pathological data of 81 consecutive patients with squamous cell carcinoma of the penis were analyzed retrospectively. Age at presentation ranged from 27 to 81 years with a median of 49 years. Course of disease within one year of patients with 46 cases (56.8%), 1 year above 35 eases (43.2 %). Seventyfive patients underwent bilateral inguinal lymph node dissection, and 6 patients had unilateral inguinal lymph node dissection. Clinical stage of the primary tumor was assigned according to the 2002 TNM staging system. Variables included patients' age, redundant prepuce and/or phimosis, tumor site,size, number, macroscopic growth pattern, histological grade, inguinal physical examination and the size of inguinal lymph nodes. Results Of the 81 patients, 42 (51.9%) were staged as pN+ and 39 (48. 1%) as pN0. Metastases occurred in 32.0% (16/50) of G1, 78.3% (18/23) of G2 and 100. 0%(8/8) of G3 cases, with significant differences among them (P= 0. 015). According to the inguinal lymph node physical examination results, 63 were staged as clinically node-positive (cN+) and 18 as clinically node-negative (cN0). Metastases occurred in 63. 5% (40/63) of cases of cN+, as compared with 11.1% (2/18) of cases of cN0(P=0. 012). At a median follow up of 40 months (ranged 2-127 months), the 5-year disease free survival rates for positive and negative inguinal lymph nodes metastasis were 71.4% and 92.3%, respectively (P=0. 005) , and the 5-year cancer specific survival rates were 79.0% and 91.4%, respectively (P=0.001). Conclusions Inguinal physical examination and histological grade were the strongest predictors of inguinal metastasis. The patients with inguinal lymph nodes metastasis have lower 5-year disease free survival rates and cancer specific survival rates,and should receive positive treatment measures.