Abstract
Squamous cell carcinoma (SCC) of the penis is an uncommon disease in the US and Europe. Without treatment, patients with penile SCC usually die within 2 years after diagnosis of the primary lesion, because of uncontrollable locoregional disease or from distant metastases. The spread of the tumor to the locoregional lymph nodes (lymph-node positivity) is the most relevant prognostic factor. With the available treatments, 5-year cancer-specific survival probabilities are between 75% and 93% for those patients with clinically node-negative disease, and progressively lower for those with increasingly extensive node-positive disease. Similarly, patients with pathologically proven negative nodes have 5-year cancer-specific survival probabilities ranging from 85% to 100%. While patients with a single positive superficial lymph node on pathology have very good cancer-related outcomes, patients with multiple involved lymph nodes have significantly less favorable outcomes. This article focuses on the most important issues that surround the prognosis of squamous cell carcinoma of the penis, with special attention to the prognostic nomograms for penile cancer patients published in 2006.
Key Points
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Squamous cell carcinoma (SCC) of the penis is an uncommon malignant disease, which substantially limits the value of epidemiologic studies and comprehension of risk factors
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Without treatment, patients with penile SCC usually die within 2 years after diagnosis of the primary lesion, because of complications due to uncontrollable locoregional growth or from distant metastases
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The main clinical and pathologic prognostic variables are lymph node stage, venous embolization, and lymphatic embolization
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Prognostic nomograms that incorporate pathologic variables have been developed, which might be useful for patient counseling and planning of treatment with regard to early inguinal lymphadenectomy and (when available) adjuvant therapies; however, the external validation of these nomograms is ongoing
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A few studies indicate a possible prognostic role for molecular markers, such as expression of tumor-suppressor genes, adhesion molecules and metalloproteinases, but further research is needed in this field
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The research performed on SCC in other areas of the body (such as the head and neck) as well as multi-institutional collaborations that pool the number of cases of penile SCC will be useful to increase the available knowledge on penile SCC
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Novara, G., Galfano, A., De Marco, V. et al. Prognostic factors in squamous cell carcinoma of the penis. Nat Rev Urol 4, 140–146 (2007). https://doi.org/10.1038/ncpuro0751
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DOI: https://doi.org/10.1038/ncpuro0751
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