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A modified clinicopathological tumor staging system for survival prediction of patients with penile cancer

Cancer Communications 2018年第1期38卷 726-735页

作者： Zai-Shang Li Antonio Augusto Ornellas christian schwentner Xiang Li Alcides Chaux Georges Netto Arthur LBurnett Yong Tang JiunHung Geng Kai Yao Xiao-Feng Chen Bin Wang Hong Liao Nan Liu Peng Chen Yong-Hong Lei Qi-Wu Mi Hui-Lan Rao Ying-Ming Xiao Qi-Lin Wang Zi-Ke Qin Zhuo-Wei Liu Yong-Hong Li Zi-Jun Zou Jun-Hang Luo Hui Li Hui Han Fang-Jian Zhou Department of Urology Shenzhen People’s HospitalThe Second Clinical College of Jinan UniversityShenzhen 518060GuangdongP.R.China Sun Yat-sen University Cancer Center State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center of Cancer MedicineGuangzhou 510060GuangdongP.R.China Department of Urology Sun Yat-sen University Cancer Center651 Dongfeng RoadEast Guangzhou 510060GuangdongP.R.China Department of Urology Brazilian National Institute of Cancer and Hospital Mário KröeffRio de Janeiro 20230-130Brazil Section of Urology National Institute of CancerRio de JaneiroBrazil Department of Urology Diakonie Klinikum Stuttgart70174 StuttgartGermany Urological Department Urological InstituteWest China Hospital of Sichuan UniversityChengdu 610041SichuanP.R.China Department of Scientific Research Norte University1001-1925 AsunciónParaguay Department of Pathology Johns Hopkins UniversityBaltimoreMD 21218USA Department of Urology Johns Hopkins UniversityBaltimoreMD 21218USA Department of Urology Affiliated Cancer Hospital of Guangxi Medical UniversityNanning 530021GuangxiP.R.China Department of Urology Kaohsiung Medical University HospitalKaohsiungTaiwan 807China Department of Urology The First People’s Hospital of ChenzhouChenzhou 423000HunanP.R.China Department of Urology Cancer Center of Guangzhou Medical UniversityGuangzhou 510000GuangdongP.R.China Department of Urology Sichuan Cancer HospitalChengdu 610041SichuanP.R.China Department of Urology Oncological Surgery Chongqing Cancer Hospital&Institute&Cancer CenterChongqing 400040China Department of Urology Affiliated Tumor Hospital of Xinjiang Medical UniversityUrumqi 830011XinjiangP.R.China Department of Urology Yunnan Provincial Tumor HospitalThe Third Affiliated Hospital of Kunming Medical UniversityKunming 650118YunnanP.R.China Department of Urology Dongguan People’s HospitalDongguan 523059GuangdongP.R.China Department of Pathology Sun Yat-sen University Cancer CenterGuangzhou 510060Guangdo

Background:The 8th American Joint Committee on Cancer tumor-node-metastasis(AJCC-TNM)staging system is based on a few retrospective single-center *** aimed to test the prognostic validity of the staging system and to determine whether a modified clinicopathological tumor staging system that includes lymphovascular emboliza-tion could increase the accuracy of prognostic prediction for patients with stage T2-3 penile ***:A training cohort of 411 patients who were treated at 2 centers in China and Brazil between 2000 and 2015 were staged according to the 8th AJCC-TNM staging *** internal validation was analyzed by bootstrap-corrected C-indexes(resampled 1000 times).Data from 436 patients who were treated at 15 centers over four conti-nents were used for external ***:A survivorship overlap was observed between T2 and T3 patients(P=0.587)classified according to the 8th AJCC-TNM staging *** embolization was a significant prognostic factor for metastasis and survival(all P<0.001).Based on the multivariate analysis,only lymphovascular embolization showed a significant influ-ence on cancer-specific survival(CSS)(hazard ratio=1.587,95%confidence interval=1.253-2.011;P=0.001).T2 and T3 patients with lymphovascular embolization showed significantly shorter CSS than did those without lymphovascu-lar embolization(P<0.001).Therefore,a modified clinicopathological staging system was proposed,with the T2 and T3 categories of the 8th AJCC-TNM staging system being subdivided into two new categories as follows:t2 tumors invade the corpus spongiosum and/or corpora cavernosa and/or urethra without lymphovascular invasion,and t3 tumors invade the corpus spongiosum and/or corpora cavernosa and/or urethra with lymphovascular *** modified staging system involving lymphovascular embolization showed improved prognostic stratification with significant differences in CSS among all categories(all P<0.005)and exhibited higher accur

关键词： Penile neoplasms Lymph node metastasis Staging Lymph node excision Prognosis

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阴茎癌改良临床病理肿瘤分期预后意义分析

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癌症 2019年第6期38卷 261-271页

作者： Zai-Shang Li Antonio Augusto Ornellas christian schwentner Xiang Li Alcides Chaux Georges Netto Arthur L.Burnett Yong Tang Jiun Hung Geng Kai Yao Xiao-Feng Chen Bin Wang Hong Liao Nan Liu Peng Chen Yong-Hong Lei Qi-Wu Mi Hui-Lan Rao Ying-Ming Xiao Qi-Lin Wang Zi-Ke Qin Zhuo-Wei Liu Yong-Hong Li Zi-Jun Zou Jun-Hang Luo Hui Li Hui Han Fang-Jian Zhou 深圳市人民医院泌尿外科暨南大学第二临床学院广东深圳518060 Department of Urology Johns Hopkins UniversityBaltimoreMD 21218USA 广西医科大学附属肿瘤医院泌尿外科广西南宁530021 高雄医科大学附属医院泌尿外科台湾高雄807 郴州市第一人民医院泌尿外科湖南郴州423000 广州医科大学肿瘤中心泌尿外科广东广州510000 四川省肿瘤医院泌尿外科四川成都610041 重庆市肿瘤医院&肿瘤研究所&癌症中心泌尿肿瘤外科重庆400040 新疆医科大学附属肿瘤医院泌尿外科新疆乌鲁木齐830011 云南省肿瘤医院昆明医科大学第三附属医院泌尿外科云南昆明650118 东莞市人民医院泌尿外科广东东莞523059 中山大学肿瘤防治中心华南肿瘤学国家重点实验室肿瘤医学协同创新中心广东广州 510060 中山大学肿瘤防治中心病理科广东广州510060 中山大学附属第一医院泌尿外科广东广州510000 香港中文大学病理学系香港999077 中山大学肿瘤防治中心泌尿外科广东广州510060 Department of Urology Brazilian National Institute of Cancer and Hospital Mario KroeffRio de Janeiro 20230-130Brazil Section of Urology National Institute of CancerRio de Janeiro Brazil Department of Urology Diakonie Klinikum StuttgartGermany 四川大学华西医院泌尿外科四川成都610041 Department of Scientific Research Norte University1001-1925 AsuncionParaguay Department of Pathology Johns Hopkins UniversityBaltimoreMD21218USA

背景与目的第8版美国癌症联合会-TNM(American Joint Committee on Cancer tumor–node–metastasis,AJCC-TNM)分期基于的是一些回顾性单中心研究。本研究旨在分析分期的预后价值,并探讨加入脉管癌栓的改良的临床病理肿瘤分期能否提高... 详细信息

背景与目的第8版美国癌症联合会-TNM(American Joint Committee on Cancer tumor–node–metastasis,AJCC-TNM)分期基于的是一些回顾性单中心研究。本研究旨在分析分期的预后价值,并探讨加入脉管癌栓的改良的临床病理肿瘤分期能否提高对T2–3期阴茎癌患者预后预测的准确性。方法根据第8版AJCC-TNM分期对2000年至2015年在中国和巴西2个中心接受治疗的411例患者所组成的训练队列进行分期。采用C-indexes一致性系数进行预测模型的评估,Bbootstrap再抽样法(1000次)进行模型验证。采用来自4个大洲15个中心接受治疗的436例患者的数据进行外部验证。结果根据第8版AJCC-TNM分期的T2和T3期患者有存活率重叠(P=0.587)。脉管癌栓是转移和生存的重要预后因素(均P <0.001)。多因素分析显示,仅脉管癌栓对癌症特异性生存(cancer-specific survival,CSS)有显著影响(风险比=1.587,95%置信区间=1.253–2.011;P=0.001)。发生脉管癌栓的T2和T3期患者的CSS显著短于无脉管癌栓的患者(P <0.001)。因此,我们提出一种改良的临床病理分期,将第8版AJCC-TNM分期的T2和T3期细分为如下2个新类别:T2期肿瘤侵犯尿道海绵体和/或阴茎海绵体和/或尿道且无淋巴管侵犯;T3期肿瘤侵犯尿道海绵体和/或阴茎海绵体和/或尿道并有淋巴管侵犯。加入脉管癌栓的改良的分期显示出预后分层改善,各组间CSS差异显著(均P <0.005),患者预后预测的准确性高于第8版AJCC-TNM分期(C-index,0.739 vs. 0.696)。以上结果在外部验证队列中得到了确认。结论 T2–3期阴茎癌是异质性的,加入脉管癌栓的改良临床病理分期比第8版AJCC-TNM分期对阴茎癌患者的预后预测能力更强。

关键词：阴茎肿瘤淋巴结转移分期淋巴结清扫预后

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