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Der Einfluss des T-Stadiums auf das Metastasierungsrisiko des Peniskarzinoms: T1 vs. T2

The influence of the T stage on the risk of metastasis of penis cancer: T1 vs. T2

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Zusammenfassung

Hintergrund

Das therapeutische Vorgehen bei Patienten mit einem T1-Peniskarzinom insbesondere bei unauffälligen Leistenlymphknoten wird kontrovers diskutiert. Die Datenlage für Lymphknotenmetastasen (LKM) ist widersprüchlich. Ziel dieser Studie war es, das Metastasierungsrisiko des T1-Karzinoms näher zu charakterisieren und mit dem des T2-Karzinoms zu vergleichen.

Material und Methoden

37 Patienten mit einem T1- oder T2-Karzinom wurden analysiert. Der Nodalstatus basierte auf Lymphadenektomiepräparaten bei 29 oder klinischer Nachbeobachtung bei 8 Patienten (22–162, Durchschnitt 62 Monate).

Ergebnisse

Die Tumordifferenzierung war gut (G1), mäßig (G2) bzw. schlecht (G3) bei 7, 26 bzw. 4 Patienten. In 21 Fällen lag ein T1- und in 16 Fällen T2-Stadium vor. LKM wurden in 8 der 21 T1- (38%) und 6 der 16 T2-Tumoren (38%) beobachtet. Keiner der G1- und alle der G3-Tumoren haben unabhängig vom T-Stadium LKM ausgebildet. 10 der 26 G2-Karzinome (38%) entwickelten LKM, davon 7 (70%) mit einem T1-Karzinom.

Schlussfolgerung

Das metastatische Potential der T1-Karzinome ist in der bisherigen Literatur unterschätzt worden. Der Differenzierungsgrad des Primärtumors hat in T1- und T2-Karzinomen einen wesentlich höheren Einfluss auf die Metastasierungsfrequenz als das T-Stadium. Daher sollte bereits ab einem T1G2-Stadium die Indikation zu einem chirurgischen Lymphknotenstaging gestellt werden.

Abstract

Background

Controversies persist over the therapeutic approach to T1 penile carcinoma, particularly in patients with negative inguinal lymph nodes. Available data on lymph nodes metastases (LNM) in T1 carcinoma are contradictory. The aim of this study was to evaluate the metastatic risk of T1 carcinoma and to compare it with that of T2 carcinoma.

Material and methods

A total of 37 patients (pts) with T1 or T2 tumors were reviewed. Assessment of the inguinal lymph node condition was based on node dissection in 29 pts and surveillance in eight pts (mean 62 months, range 22–162).

Results

Grading was classified as good (G1), moderate (G2) and poor (G3) in seven, 26 and four pts, respectively. Tumor stage was T1 in 21 and T2 in 16 pts. LNM were observed in eight of 21 T1 (38%) and six of 16 T2 tumors (38%). No G1 and all G3 tumors developed LNM independently of tumor stage. Ten of the 26 G2 carcinomas (38%) harboured LNM and seven of these pts (70%) had a T1 tumor.

Conclusions

According to our data, the metastatic potential of T1 penile carcinoma has been underestimated in the recent literature. Tumor grading has a substantially stronger impact on the metastatic risk in T1 and T2 penile carcinoma than tumor stage, indicating a surgical lymph node staging starting at the pT1G2 stage.

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Authors and Affiliations

  1. Abteilung für Urologie und Kinderurologie, Universitätsklinikum, Ulm, Deutschland

    B. Volkmer, F. Kurtz & R. Hautmann

  2. Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 7, 24105, Kiel, Deutschland

    C. M. Naumann, C. van der Horst, F. J. Martinéz Portillo, C. Seif, S. Hautmann, P. M. Braun & K.-P. Jünemann

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  1. C. M. Naumann
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  2. C. van der Horst
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  3. B. Volkmer
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  4. F. Kurtz
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  5. F. J. Martinéz Portillo
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  6. C. Seif
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  7. S. Hautmann
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Correspondence to C. M. Naumann.

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Naumann, C.M., van der Horst, C., Volkmer, B. et al. Der Einfluss des T-Stadiums auf das Metastasierungsrisiko des Peniskarzinoms: T1 vs. T2. Urologe 45, 1424–1430 (2006). https://doi.org/10.1007/s00120-006-1160-1

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  • DOI: https://doi.org/10.1007/s00120-006-1160-1

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