Abstract
Introduction
Accurate tumor staging is essential in the management of malignancies. It provides a guide in selecting accurate treatment and gives an indication of prognosis based on the extent of disease. The current TNM classification for penile carcinoma has remained unchanged since 1987. In this article, we focus on several deficiencies of the current classification.
Materials and methods
An analysis of the current literature regarding the current classification was done, focusing on known prognostic factors for survival. Furthermore, we discuss in detail the results from a recent analysis of more than 500 patients treated at our institute to evaluate the practical and prognostic value of the TNM-classification.
Results
We found that, using the current classification system, accurate clinical staging is often difficult, because the T and N categories are defined by structures that are not easily identified using physical examination or imaging. Furthermore, the prognostic stratification of the present staging system is not optimal and there is a substantial overlap in disease-specific survival between several categories. We give an overview of modifications that could improve clinical staging and prognostic ability.
Conclusion
The current TNM classification for penile carcinoma has several shortcomings in terms of usability in clinical staging and prognostic value. With modifications clinical staging is facilitated, while the prognostic stratification of the classification is improved.
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References
Baker BH, Watson FR (1975) Staging carcinoma of the penis. J Surg Oncol 7(3):243–248
Jackson SM (1966) The treatment of carcinoma of the penis. Br J Surg 53(1):33–35
Sobin LH, Wittekind CH (2002) TNM classification of malignant tumours. Wiley-Liss, London
Harmer MH (1978) TNM classification of malignant tumors. UICC, Geneva
CC UI (1968) TNM classification of malignant tumours (Livre de Poche). UICC, Geneva
Leijte JA, Gallee MP, Antonini N et al (2008) Evaluation of current TNM classification for penile carcinoma. J Urol. doi:10.1016/j.juro.2008.05.11
Hegarty PK, Kayes O, Freeman A et al (2006) A prospective study of 100 cases of penile cancer managed according to European Association of Urology guidelines. BJU Int 98(3):526–531
McDougal WS (1995) Carcinoma of the penis: improved survival by early regional lymphadenectomy based on the histological grade and depth of invasion of the primary lesion. J Urol 154(4):1364–1366
Solsona E, Iborra I, Ricos JV et al (1992) Corpus cavernosum invasion and tumor grade in the prediction of lymph node condition in penile carcinoma. Eur Urol 22(2):115–118
Soria JC, Fizazi K, Piron D et al (1997) Squamous cell carcinoma of the penis: multivariate analysis of prognostic factors and natural history in monocentric study with a conservative policy. Ann Oncol 8(11):1089–1098
Horenblas S, van Tinteren H, Delemarre JF et al (1993) Squamous cell carcinoma of the penis III treatment of regional lymph nodes. J Urol 149(2 Pt 3):492–497
Culkin DJ, Beer TM (2003) Advanced penile carcinoma. J Urol 170(1):359–365
Solsona E, Algaba F, Horenblas S et al (2004) EAU guidelines on penile cancer. Eur Urol 46(1):1–8
Pandey D, Mahajan V, Kannan RR (2006) Prognostic factors in node-positive carcinoma of the penis. J Surg Oncol 93(2):133–138
Ravi R (1993) Correlation between the extent of nodal involvement and survival following groin dissection for carcinoma of the penis. Br J Urol 72(3 Pt 2):817–819
Lont AP, Kroon BK, Gallee MP et al (2007) Pelvic lymph node dissection for penile carcinoma: extent of inguinal lymph node involvement as an indicator for pelvic lymph node involvement and survival. J Urol 177(3):947–952
Daseler EH, Anson BJ, Reimann AF (1948) Radical excision of the inguinal and iliac lymph glands. A study based upon 450 anatomical dissections and upon supportive clinical observations. Surg Gynecol Obstet 87:679–694 Ref type: generic
Srinivas V, Morse MJ, Herr HW et al (1987) Penile cancer: relation of extent of nodal metastasis to survival. J Urol 137(5):880–882
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Leijte, J.A.P., Horenblas, S. Shortcomings of the current TNM classification for penile carcinoma: time for a change?. World J Urol 27, 151–154 (2009). https://doi.org/10.1007/s00345-008-0308-6
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DOI: https://doi.org/10.1007/s00345-008-0308-6