Delay to Inguinal Lymph Node Dissection Greater than 3 Months Predicts Poorer Recurrence-Free Survival for Patients with Penile Cancer
Delay to Inguinal Lymph Node Dissection Greater than 3 Months Predicts Poorer Recurrence-Free Survival for Patients with Penile Cancer
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DOI：
10.1016/j.juro.2017.06.076
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发表时间：
2017-12-01
影响因子：
6.6
通讯作者：
Spiess, Philippe E.
中科院分区：
文献类型：
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作者：
Chipollini, Juan;Tang, Dominic H.;Spiess, Philippe E.
目的：据我们所知，尚不清楚阴茎切除术时同时进行腹股沟淋巴结清扫是否可以改善阴茎癌患者的预后。我们根据腹股沟淋巴结清扫的时间分析了区域复发和疾病特异性生存的预测因素。我们还确定了进行腹股沟淋巴结清扫术的最佳时间。材料和方法：我们回顾了 84 名连续患者的记录，这些患者均具有可用的淋巴结病理学结果。使用 Kaplan-Meier 方法估计无复发生存率和疾病特异性生存率。通过 ROC 曲线评估腹股沟淋巴结清扫的最佳时间并用于二分法。 Cox 比例 HR 用于确定腹股沟淋巴结清扫术后区域复发的预测因素。结果：在中位随访 21 个月期间，共有 47 名 (56%) 和 37 名患者 (44%) 分别出现 cN0 和 cN_ 疾病。使用 3 个月进行腹股沟淋巴结清扫术的截止点将队列分为早期组和延迟组。 51 名接受早期切除的男性的 5 年无复发生存率为 77%，而 33 名接受延迟切除的男性的 5 年无复发生存率为 37.8%。淋巴结阳性（HR 23.2，95% CI 2.98-181.2）和早期腹股沟淋巴结清扫术（HR 0.48，95% CI 0.21-0.98）是区域复发的预测因素。早期和晚期清扫组的五年疾病特异性生存率分别为 64.1% 和 39.5%。结论：三个月似乎是进行腹股沟淋巴结清扫术的最佳窗口期。虽然需要前瞻性试验来确定前期腹股沟淋巴结清扫术的作用，但我们的结果可能有助于确定阴茎癌患者腹股沟淋巴结清扫术的转诊模式和时机。
Purpose: To our knowledge it is unknown whether concomitant inguinal lymph node dissection at the time of penectomy improves outcomes in patients with penile cancer. We analyzed predictors of regional recurrence as well as disease specific survival based on time of inguinal lymph node dissection. We also determined an optimal time to perform inguinal lymph node dissection.Materials and Methods: We reviewed the records of 84 consecutive patients with available nodal pathology findings. Recurrence-free and disease specific survival was estimated using the Kaplan-Meier method. Optimal time to inguinal lymph node dissection was assessed by ROC curves and used for dichotomization. Cox proportional HRs were used to identify predictors of regional recurrence after inguinal lymph node dissection.Results: A total of 47 (56%) and 37 patients (44%) presented with cN0 and cN_ disease, respectively, during a median followup of 21 months. A cutoff point of 3 months to perform inguinal lymph node dissection was used to dichotomize the cohort into early vs delayed groups. Early dissection in 51 men demonstrated 5-year recurrence-free survival of 77% vs 37.8% in 33 who underwent delayed dissection. Positive node disease (HR 23.2, 95% CI 2.98-181.2) and early inguinal lymph node dissection (HR 0.48, 95% CI 0.21-0.98) were predictors of regional recurrence. Five-year disease specific survival was 64.1% and 39.5% in the early and late dissection groups, respectively.Conclusions: Three months appears to be an optimal window for performing inguinal lymph node dissection. While prospective trials are needed to define the role of upfront groin dissection, our results may help delineate patterns of referral and timing of inguinal lymph node dissection in patients with penile cancer.