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More lymph node dissection improves survival in patients with newly diagnosed lymph node-positive penile cancer

  • Urology - Original Paper
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Abstract

Purpose

For patients with lymph node-positive (LN+) penile cancer, the optimal extent of lymph node dissection (LND) is currently not established. We aimed to reveal the potential association between survival and the number of LND in patients with newly diagnosed LN + penile cancer.

Methods

Patients with LN + penile cancer diagnosed between 2004 and 2015 were identified using the SEER database. The relationships between the number of removed lymph nodes and overall survival (OS), all-cause mortality (ACM), cancer-specific mortality (CSM), and 5-year mortality were tested. Kaplan–Meier curves as well as univariate and multivariable cox regression were used to further analyze disparities in mortality and survival.

Results

Among 599 eligible patients with LN + penile cancer, 527 (88.0%) received surgery and 72 (12.0%) did not. Compared with those who had not received surgery, patients receiving surgery had longer overall survival (28.31 ± 30.84 versus 16.69 ± 21.68 months) and longer median survival (15.00 versus 8.00 months) times. Univariate analyses demonstrated the number of LND to be an independent factor. Multivariable Cox regression analyses suggested that the ≥ 8 removed lymph nodes predicted a lower ACM rate (hazard ratio (HR) = 0.48, 95% CI 0.38–0.61, p < 0.001), penile CSM rate (HR = 0.42, 95% CI 0.30–0.57, p < 0.001), and lower 5-year mortality (HR = 0.58, 95% CI 0.47–0.71, p < 0.001).

Conclusions

In patients with newly diagnosed LN + penile cancer, more LND during lymphadenectomy was associated with an improvement in ACM, CSM rate, and 5-year mortality. Therefore, patients with preoperatively LN + penile cancer should undergo LND to have more lymph nodes removed.

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Abbreviations

LN+:

Lymph node-positive

LND:

Lymph node dissection

OS:

Overall survival

ACM:

All-cause mortality

CSM:

Cancer-specific mortality

SEER:

Surveillance, Epidemiology, and End Results

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Funding

This work was supported by grant 1501219143 and 81001134 to Jiang Geng.

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Author notes

  1. Weipu Mao, Xin Huang, and Minghao Kong have contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Shanghai Tenth People’s Hospital, Tongji University, No. 301, Yanchang Road, Jing’an District, Shanghai, 200072, China

    Weipu Mao, Xin Huang & Jiang Geng

  2. Department of Emergency, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, 200072, China

    Minghao Kong

  3. Department of Pathology, Huashan Hospital, Fudan University, Shanghai, 200040, China

    Jie Fan

Authors
  1. Weipu Mao
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  2. Xin Huang
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  3. Minghao Kong
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  4. Jie Fan
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  5. Jiang Geng
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Contributions

WM, JF, and JG were involved in the study conception and design. WM, JG collected and assembled data. WM, JF, and JG were involved in data analysis and interpretation WM, XH, and MK wrote the manuscript.

Corresponding authors

Correspondence to Jie Fan or Jiang Geng.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Mao, W., Huang, X., Kong, M. et al. More lymph node dissection improves survival in patients with newly diagnosed lymph node-positive penile cancer. Int Urol Nephrol 51, 641–654 (2019). https://doi.org/10.1007/s11255-019-02084-7

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