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目的:将国际抗癌协会-美国肿瘤联合委员会(Union for International Cancer Control-American Joint Committee on Cancer,UICC-AJCC)第7版阴茎癌病理N2(pN2)期分为pN2a期(单侧多发腹股沟淋巴结结内转移)和pN2b期(双侧腹股沟淋巴结结内转移),探讨阴茎癌改良pN2分期的预后意义。方法:回顾分析中山大学肿瘤防治中心2002-12-01-2012-06-30收治的153例阴茎癌患者资料。将pN2期患者,按照腹股沟淋巴结转移侧数分为pN2a和pN2b两组,分析pN2a和pN2b期患者的临床病理特点及与预后关系。Kaplan-Meier法进行疾病特异性生存率(disease specific surrival,DSS)分析并采用Log-rank检验进行比较。Logistic回归分析评价第7版pN分期和改良pN分期系统比较。采用χ2值、AIC标准和c-index一致性系数比较预测预后准确度。结果:71例患者病理确诊腹股沟淋巴结转移并纳入研究。清除淋巴结中位数为22(5~53)个,其中阳性淋巴结中位数3(1~16)个。pN1患者21例(29.6%),3年DSS为94.4%;pN2患者33例(46.5%),3年DSS为69.6%;pN3患者17例(23.9%),3年DSS为27.2%。按照改良的病理N2分期标准,pN2a期的3年DSS为84.7%(19例);pN2b期的3年DSS为50.1%(14例),两组之间的DSS差异有统计学意义,P=0.034。计入淋巴结转移侧数的阴茎癌改良病理N2分期系统在预测预后方面的准确性显著增加。结论:阴茎癌改良pN2分期较第7版阴茎癌pN2分期能更好地预测疾病特异生存率,但尚需外部资料验证以进一步明确其有效性。
OBJECTIVE: To divide the 7th edition of the penile cancer pathology N2 (pN2) phase of the Union for International Cancer Control-American Joint Committee on Cancer (UICC-AJCC) into pN2a (unilateral multiple inguinal lymph nodes Intranodal metastasis) and pN2b (bilateral inguinal lymph node metastasis), to explore the prognostic significance of improved penile cancer pN2 staging. Methods: A retrospective analysis of Sun Yat-sen University Cancer Center 2002-12-01-2012-06-30 153 cases of penile cancer patients admitted to the data. The patients with pN2 stage were divided into two groups according to the number of inguinal lymph node metastases: pN2a and pN2b. The clinicopathological features and prognosis of pN2a and pN2b patients were analyzed. Kaplan-Meier method for disease-specific surrival (DSS) analysis and Log-rank test for comparison. Logistic regression analysis to compare the 7th edition of pN staging and modified pN staging system. The χ2 value, AIC standard and c-index consistency coefficient were used to predict the prognostic accuracy. Results: 71 cases of pathologically confirmed inguinal lymph node metastasis and included in the study. The median lymph node clearance was 22 (ranged from 5 to 53), with a median of 3 (1 to 16) positive lymph nodes. 21 patients (29.6%) had pN1 patients, and 94.4% had 3 years DSS. 33 patients (46.5%) had pN2 patients, 69.6% had 3 years DSS, 17 patients (23.9%) had pN3 patients, and 27.2% had 3 years DSS. According to the improved pathologic N2 staging criteria, the 3-year DSS of pN2a was 84.7% (19 cases), and the 3-year DSS of pN2b was 50.1% (14 cases). There was a significant difference in DSS between the two groups (P = 0.034. The accuracy of predicting the prognosis of patients with benign and malignant penile cancer with staging of lymph node metastases is significantly increased. CONCLUSIONS: The improved pN2 staging of penile cancer is more predictive of disease-specific survival than the 7th edition of penile cancer pN2 staging. However, external data validation is needed to further clarify its effectiveness.