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目的探讨阴茎鳞癌原发灶组织病理学特点对患者区域性淋巴结转移的预测作用。方法回顾分析72例阴茎鳞癌患者临床病理资料。其中58例行双侧腹股沟淋巴结清扫术,9例行一侧或双侧盆腔淋巴结清扫术。按WHO 2004年阴茎癌分型分级标准及AJCC 2002年TNM分期标准重新分型分级分期,并记录原发灶浸润深度、脉管中有无癌栓、区域性淋巴结转移数目、部位等指标。结果8例原发灶为疣状癌者均未发生区域性淋巴结转移,5例基底样鳞癌者均发生淋巴结转移,9例疣性鳞癌中3例(30.0%)、50例经典型鳞癌者中15例(33.3%)发生淋巴结转移,各组间差异有统计学意义(P=0.002)。40例原发灶为Ta及T1者中6例(15.0%)发生区域性淋巴结转移,32例T2及T3者中17例(53.1%)发生淋巴结转移,2组比较差异有统计学意义(P<0.001)。24例G1、31例G2、17例G3患者中分别发生淋巴结转移5例(20.8%)、10例(32.3%)、8例(47.1%),组间比较差异无统计学意义(P>0.05)。淋巴结有转移者其原发灶浸润深度平均9.3 mm,无转移者为2.7mm,2组差异有统计学意义(P<0.001)。结论阴茎鳞癌原发灶的病理分型、分期和浸润深度与区域性淋巴结转移之间关系密切。综合运用这些指标可以预测淋巴结的转移状况以指导临床治疗。
Objective To investigate the predictive value of histopathological features of primary tumor in penile squamous cell carcinoma on regional lymph node metastasis in patients with squamous cell carcinoma of the penis. Methods Retrospective analysis of 72 cases of penile squamous cell carcinoma of the clinical and pathological data. 58 cases of bilateral inguinal lymphadenectomy, 9 cases of one or both of the pelvic lymph node dissection. According to WHO classification of penile cancer in 2004 and AJCC 2002 TNM staging criteria for re-classification staging, and the depth of invasion of the primary tumor, the presence or absence of tumor emboli in the vessel, the number of regional lymph node metastasis, site and other indicators. Results No lymph node metastasis occurred in 8 cases of primary verrucous carcinoma, 5 cases of basal squamous cell carcinoma all had lymph node metastasis, 3 cases (30.0%) of 9 cases of warty squamous cell carcinoma, 50 cases of classic squamous cell carcinoma Lymph node metastasis occurred in 15 cases (33.3%) of the cancer patients, with significant difference between the groups (P = 0.002). Lymph node metastasis occurred in 6 of 40 cases (15.0%) in 40 cases of primary tumor and in T1, of which 17 cases (53.1%) in 32 cases of T2 and T3, the difference was statistically significant (P <0.001). There were 5 cases (20.8%), 10 cases (32.3%) and 8 cases (47.1%) of lymph node metastasis in 24 cases of G1, 31 cases of G2 and 17 cases of G3. There was no significant difference between the two groups (P> 0.05 ). The depth of invasion of primary lymph nodes in patients with lymph node metastasis was 9.3 mm in average and 2.7 mm in those without metastasis. The difference between the two groups was statistically significant (P <0.001). Conclusion The pathological type, stage and infiltration depth of primary tumor of penile squamous cell carcinoma are closely related to regional lymph node metastasis. Comprehensive use of these indicators can predict the status of lymph node metastasis to guide clinical treatment.