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目的探讨加入腹股沟淋巴结转移个数及腹股沟转移侧数的阴茎癌改良病理N分期在中国人群患者中的预测价值。方法回顾性分析1999年3月至2013年1月中山大学附属肿瘤医院团队治疗的246例阴茎鳞状细胞癌患者的临床及病理资料。所有患者均接受原发灶处理及改良根治腹股沟淋巴结清扫术治疗并采用标准化方式收获淋巴结(清扫淋巴结数目≥8枚)。Kaplan-Meier法进行疾病特异性生存率(DSS)分析并采用Log-rank检验进行比较,Cox比例风险模型进行多因素分析。卡方检验、AIC标准和C-index一致性系数进行预测模型的评估。Bootstrap再抽样法(500次)进行模型验证。结果最终111例阴茎癌患者纳入分析。按照国际抗癌联盟-美国癌症联合委员会(UICC-AJCC)的第7版病理N分期标准,pN1、pN2、pN3患者3年DSS分别为89.6%、65.9%、33.6%(P_(N1-N2)=0.030,P_(N2-N3)<0.001,P<0.001);按照改良病理分期标准,pN1、pN2、pN3患者3年DSS分别为90.7%、60.5%、31.4%(P_(N1-N2)=0.005,P_(N2-N3)=0.004,P<0.001)。在多种Cox多因素分析中,仅改良病理N分期具有预测价值(HR:4.877,10.895;P=0.018,<0.001)。模型评估结果显示改良病理N分期系统在中国人群中的预测准确性显著增加。结论阴茎癌改良病理N分期可以更好地预测中国人群患者的预后。阴茎癌改良病理N分期可有利于指导个体化治疗。
Objective To investigate the predictive value of modified staging of penile cancer in patients with Chinese population by adding the number of inguinal lymph node metastases and the number of lateral groin metastases. Methods The clinical and pathological data of 246 patients with squamous cell carcinoma of the penis from March 1999 to January 2013 in Cancer Hospital affiliated to Sun Yat-sen University were retrospectively analyzed. All patients underwent primary treatment and modified radical inguinal lymph node dissection. Normalized lymph nodes were harvested (number of lymph nodes> 8). Kaplan-Meier method for disease-specific survival (DSS) analysis and use of Log-rank test for comparison, Cox proportional hazards model for multivariate analysis. Chi-square test, AIC standard and C-index consistency coefficient to evaluate the prediction model. Bootstrap re-sampling method (500 times) for model verification. Results The final 111 cases of penile cancer were included in the analysis. According to the seventh edition of the UICC-AJCC pathological N staging criteria, the 3-year DSS of patients with pN1, pN2 and pN3 were 89.6%, 65.9% and 33.6% respectively (P_ (N1_N2) (P_ (0) = 0.030, P_ (N2_N3) <0.001, P <0.001). According to the improved pathological staging criteria, the 3-year DSS of patients with pN1, pN2 and pN3 were 90.7%, 60.5% and 31.4% 0.005, P_ (N2-N3) = 0.004, P <0.001). Among the multiple Cox multivariate analyzes, only improved pathologic N staging had predictive value (HR: 4.877, 10.895; P = 0.018, <0.001). The results of the model assessment showed that the accuracy of the prediction of the improved pathologic N staging system in Chinese population increased significantly. Conclusion The improved stage of penile cancer pathological N stage can better predict the prognosis of Chinese patients. Penile cancer to improve the pathological N staging can be conducive to the guidance of individualized treatment.