陰茎癌12例の臨床的検討

Abstract

Clinical studies were done on 12 patients with penile carcinoma seen during the last 5 years at our hospital between October 1, 1976 and September 30, 1981. Five of these 12 patients had features of clinical interest: 3 patients with metastatic penile carcinoma from the bladder tumor, I with sigmoid carcinoma in addition to the primary penile carcinoma (multiple primary cancer), and I with hypercalcemia taking the clinical course compatible with that of the fulminating cancer of the penis. Patient age ranged from 38 to 83 years, and the average age was older in the metastatic carcinoma group than in the primary carcinoma group. Intervals between the time of onset and the time of the first visit to our clinic ranged from 5 to 72 months in the primary carcinoma group and 0 month to 1.5 months in the secondary carcinoma group. Six of the 9 patients in the primary carcinoma group were phimotic. The presence of phimosis in the remaining 3 patients in the primary carcinoma group was unknown. The diseases of the 9 patients in the primary carcinoma group were classified according to the Jacksonian staging system: 1 patient had stage I, none had stage II, and 4 patients each had stage III and IV tumors. As described by some investigators, the clinical stage did not coincide with the stage of the disease determined histologically. Only 2 of the 6 patients who had palpable nodes had tumors in the groin. The diagnoses of the 9 patients were re-classified after lymph nodes were evaluated histologically: One patient had stage I, 3 had stage II, none had stage III and 5 had stage IV tumors. Treatment consisted of surgery, irradiation and chemotherapy. Generally at our clinic, patients with low stage tumors were approached as conservatively as possible, whereas patients with high stage tumors received radical treatment, with surgery being the main choice. High dose methotrexate with citrovorum factor rescue was started on some patients with high stage tumors. All tolerated the aggressive chemotherapy except one who showed unusually severe allergic reaction after the second dose of the infusion. Myocutaneous skin flap was used in some patients in obtaining coverage over the denuded and/or necrotic skin. Of the 9 patients in the primary group 6 died during hospitalization. One was discharged but was lost to followup. The remaining 2 patients, 1 with sigmoid carcinoma and the other with a stage IV tumor treated with high dose methotrexate, are still alive. All 3 patients in the secondary carcinoma group died within 1 year after diagnosis. One of the main reasons for the poor prognosis in the primary carcinoma group is that as many as 5 patients (56%) were referred because conventional therapy became refractile elsewhere.