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目的探讨肿瘤解剖部位与阴茎鳞癌患者临床病理特征的相关性及其对肿瘤特异性生存的影响。方法回顾性分析1998~2009年间美国“检测、流行病学和最终结果(SEER)”数据库中记录的1 959例阴茎鳞癌患者的临床资料,包括地理区域、确诊年龄、种族、婚姻状况、肿瘤解剖部位、肿瘤分级、SEER分期及阴茎癌特异性生存情况等。根据肿瘤解剖部位对患者进行分组,采用χ2检验比较各组患者的临床病理特征。运用Cox回归进行单因素及多因素生存分析。对生存函数的估计采用KaplanMeier法,并用Log-rank法对结果进行显著性检验。结果本组患者确诊时中位年龄68(21~106)岁,中位随访时间32(0~256)个月,至随访截止日期全组共有369例(18.8%)患者死于阴茎鳞癌。与肿瘤仅发生于包皮部位的患者相比,发生于其他部位的肿瘤分期较晚(P<0.001)且分化较差(P=0.001)。多因素分析结果显示,肿瘤分级(P<0.001)、SEER分期(P<0.001)及解剖部位(P=0.026)均为阴茎鳞癌特异性生存的独立预后因素。此外,肿瘤侵犯包皮以外部位的患者其长期的肿瘤特异性生存率明显降低。结论肿瘤解剖部位可能为阴茎鳞癌特异性生存的预后因素,肿瘤发生于龟头、阴茎体部或累及多个部位的患者死于阴茎癌的风险显著高于肿瘤仅发生于包皮部位者。
Objective To investigate the correlation between tumor anatomy and clinicopathological features of penile squamous cell carcinoma and its effect on tumor-specific survival. Methods The clinical data of 1 959 patients with squamous cell carcinoma of the penis recorded in the United States Database of Detection, Epidemiology and End Results (SEER) from 1998 to 2009 were retrospectively analyzed. The data included geographical area, age at diagnosis, race, marital status , Tumor anatomy, tumor grade, SEER staging and penile cancer-specific survival and so on. The patients were divided according to the anatomy of the tumor, and the clinical and pathological features of each group were compared by χ2 test. Univariate and multivariate survival analyzes were performed using Cox regression. KaplanMeier method was used to estimate the survival function, and the result was tested by Log-rank method. Results The median age at diagnosis was 68 (21 to 106) years. The median follow-up time was 32 (0 ~ 256). A total of 369 patients (18.8%) died of penile squamous cell carcinoma to the end of the follow-up period. Tumors that occurred in other sites were later (P <0.001) and poorly differentiated (P = 0.001) compared with those with tumors only in the foreskin. Multivariate analysis showed that tumor grade (P <0.001), SEER stage (P <0.001) and anatomic site (P = 0.026) were independent prognostic factors for specific survival of penis squamous cell carcinoma. In addition, long-term tumor-specific survival was significantly reduced in patients whose tumors penetrated beyond the foreskin. Conclusions The anatomic site of the tumor may be a prognostic factor for the specific survival of the penile squamous cell carcinoma. The risk of dying from penile cancer in patients with tumors in the glans penis or in multiple parts of the penis is significantly higher than that in tumors only in the foreskin.