BJU Int:阴茎癌患者腹股沟淋巴结转移的临床病理预测因子调查

2022-01-16 AlexYang MedSci原创

利用动态前哨结点活检(DSNB)特征,在阳性DSNB患者中完成腹股沟淋巴结清扫(ILND)后,建立了额外的腹股沟淋巴结转移(LNM)预测模型,目的是确定ILND可能遗漏的患者群体。

阴茎癌(PeCa)患者的5年癌症特异性生存率情况较好(81%)。然而,有淋巴结转移(LNM)患者的5年癌症特异性生存率平均为56%。发现较晚和治疗时忽略的LNM对生存不利。当没有触诊到腹股沟结节(cN0)时,仍有25%的概率出现结节转移。由于目前的成像策略不够准确,还无法检测到这些LNM。因此在cN0腹股沟盆需要进行侵入性结节分期,以尽早发现这些转移,从而提高生存率

近期,来自荷兰的研究人员在《BJU Int》杂志上发表文章,他们利用动态前哨结点活检(DSNB)特征,在阳性DSNB患者中完成腹股沟淋巴结清扫(ILND)后,建立了额外的腹股沟淋巴结转移(LNM)预测模型,目的是确定ILND可能遗漏的患者群体

研究群体来自7个欧洲中心,包括了407名DSNB阳性阴茎癌患者,这些患者随后均接受了ILND。研究人员对他们的腹股沟盆进行了回顾性研究。从组织病理学报告中,调查了阳性和阴性淋巴结的数量、有无淋巴结外扩展和转移灶的大小。使用bootstrapped逻辑回归,根据Akaike信息准则的优化,为临床预测模型选择变量。计算了模型的接收操作特征曲线下的面积(AUC),并使用决策曲线分析(DCA)评估该模型的临床效用。

结果发现,在阳性DSNBs中,64名患者(16%)在ILND时有额外的LNM。阳性DSNB的阳性结节数(几率[OR]2.19,95%置信区间(CI)1.17-4.00;P=0.01)和最大的转移灶大小(mm)(OR 1.06,95% CI 1.03-1.10;P=0.001)选入临床预测模型。计算所得的AUC为0.67(95% CI 0.60-0.74)。DCA显示使用临床预测模型并没有获得临床益处。

最终模型的校准图

综上所述,在DSNB阳性患者中完成ILND后,有一小部分临床上很重要腹股沟盆存在额外的LNM。虽然DSNB的特征与额外的LNM有关,但它们并没有改善ILND对腹股沟盆的选择。因此,在所有DSNB为阳性的腹股沟盆中,完成ILND仍然是必要的。

 

原始出处:

Hielke M de Vries , Hack Jae Lee , Wayne Lam et al. Clinicopathological predictors of finding additional inguinal lymph node metastases in penile cancer patients after positive dynamic sentinel node biopsy: a European multicentre evaluation. BJU Int. Dec 2021

 

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    2022-04-16 ms6000001586306733

    学习了

    0

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    2022-01-22 ms5000000518166734

    学习谢谢学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习

    0

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    2022-01-17 潇格拉底

    学习一个!

    0

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    2022-01-17 sodoo
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2020年1月,美国国家综合癌症网络(NCCN)发布了阴茎癌指南2020年第1版,指南主要内容涉及: 指南更新摘要 初级评估,临床诊断 Tis,Ta期疾病初级治疗 T1,T2或更晚期疾病初级治疗 不明显腹股沟淋巴结的管理 体积不大的腹股沟淋巴结的管理 体积较大的腹股沟淋巴结的管理 巨大腹股沟淋巴结的管理 监测时间表 复发性疾病的管理 转移性疾病的管控 手术治疗原则 放射治疗原则 化疗原则 分期

阴茎癌爱找中老年男性,出现这几个症状要警惕!

来自贵州的63岁的吴伯,在今年初出现龟头糜烂,偶有渗血,但却羞于启齿,一直没有到医院治疗,只是自行用消毒液清洗,但症状却越来越严重。