Background: Advanced penile carcinoma is characterized by poor prognosis. Most data on prognostic factors are based on small study cohorts, and even meta-analyses are limited in patient numbers. Therefore, there is still a lack of evidence for clinical decisions. In addition, the most recent TNM classification is questionable; in line with previous studies, we found that it has not improved prognosis estimation. Methods: We evaluated 297 patients from Germany, Russia, and Portugal. Tissue samples from 233 patients were re-analyzed by two experienced pathologists. HPV status, p16, and histopathological parameters were evaluated for all patients. Results: Advanced lymph node metastases (N2, N3) were highly significantly associated with reductions in metastasis-free (MFS), cancer-specific (CS), and overall survival (OS) rates (p= <0.001), while lymphovascular invasion was a significant parameter for reduced CS and OS (p= 0.005;p= 0.007). Concerning the primary tumor stage, a significant difference in MFS was found only between pT1b and pT1a (p= 0.017), whereas CS and OS did not significantly differ between T categories. In patients without lymph node metastasis at the time of primary diagnosis, lymphovascular invasion was a significant prognostic parameter for lower MFS (p= 0.032). Histological subtypes differed in prognosis, with the worst outcome in basaloid carcinomas, but without statistical significance. HPV status was not associated with prognosis, either in the total cohort or in the usual type alone. Conclusion: Lymphatic involvement has the highest impact on prognosis in penile cancer, whereas HPV status alone is not suitable as a prognostic parameter. The pT1b stage, which includes grading, as well as lymphovascular and perineural invasion in the T stage, seems questionable; a revision of the TNM classification is therefore required.
背景：晚期阴茎癌以预后不良为特征。关于预后因素的数据大多基于小规模研究队列，即使荟萃分析也受限于患者数量。因此，临床决策仍缺乏充分证据支持。此外，最新的TNM分期系统存在争议；与既往研究一致，我们发现其并未改善预后评估。方法：我们评估了来自德国、俄罗斯和葡萄牙的297例患者。由两位经验丰富的病理学家对其中233例患者的组织样本进行重新分析。对所有患者的人乳头瘤病毒（HPV）状态、p16表达及组织病理学参数进行评估。结果：晚期淋巴结转移（N2、N3期）与无转移生存率（MFS）、癌症特异性生存率（CS）及总生存率（OS）的显著降低密切相关（p<0.001），而淋巴血管侵犯是CS和OS降低的重要参数（p=0.005；p=0.007）。在原发肿瘤分期方面，仅pT1b与pT1a期之间的MFS存在显著差异（p=0.017），而CS和OS在T分期各亚组间无统计学差异。在初诊时无淋巴结转移的患者中，淋巴血管侵犯是MFS降低的重要预后参数（p=0.032）。不同组织学亚型的预后存在差异，基底细胞样癌预后最差，但未达统计学显著性。无论是在总体队列还是单一普通型癌中，HPV状态均与预后无显著关联。结论：淋巴系统受累对阴茎癌预后影响最为显著，而HPV状态单独作为预后参数并不适宜。包含分级评估的pT1b分期，以及T分期中纳入淋巴血管和神经侵犯的标准存在争议，因此需要对TNM分期系统进行修订。
Evaluation of Prognostic Parameters to Identify Aggressive Penile Carcinomas
肿瘤(癌症)患者之家