Advertisement

World Journal of Urology

, 27:155 | Cite as

How accurate are present risk group assignment tools in penile cancer?

  • Vincenzo FicarraEmail author
  • G. Novara
  • R. Boscolo-Berto
  • W. Artibani
  • M. W. Kattan
Topic Paper

Abstract

Objectives

To evaluate the accuracy of the predictive models available to estimate the risk of lymph node metastases and cancer-specific survival in patients with squamous cell carcinoma of the penis.

Methods

A nonsystematic review of the literature was performed searching MEDLINE in January 2008.

Results

Most of the authors select patients for early inguinal lymphadenectomy according to the pathologic extension of the primary tumor and its histologic grade, as recommended by the EAU Guidelines and the Solsona risk groups. Although the Solsona risk groups performed slightly better, both risk groups had low predictive accuracy. A nomogram including eight clinical and pathologic variables (tumor thickness, microscopic growth pattern, Broder’s grade, presence of vascular or lymphatic embolization, infiltrations of the corpora cavernosa, corpus spongiosum or urethra, and the clinical stage of groin lymph nodes) was developed to estimate the risk of lymph node involvement at follow-up. Two nomograms are currently available able to estimate the 5-year cancer-specific survival probabilities of the patients. The first nomogram included the clinical lymph node stage and the same pathological variables of the primary tumor at penectomy, while the pathological stage of the lymph nodes replaced the clinical one in the second model. All the 3 nomograms had good prognostic accuracy.

Conclusions

Both the Solsona and EAU risk group assessment had low prognostic accuracy, although the Solsona risk groups performed slightly better. The nomograms designed to predict the risk of lymph node metastases showed and cancer-specific survival had good prognostic accuracy but their external validation is still lacking.

Keywords

Squamous cell carcinoma Penile neoplasm Lymphadenectomy Nomograms 

Notes

Conflict of interest

There is no conflict of interest.

References

  1. 1.
    Mobilio G, Ficarra V (2001) Genital treatment of penile carcinoma. Curr Opin Urol 11:299–304PubMedCrossRefGoogle Scholar
  2. 2.
    Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ (2007) Cancer statistics, 2007. CA Cancer J Clin 57:43–66PubMedCrossRefGoogle Scholar
  3. 3.
    Kroon BK, Horenblas S, Nieweg OE (2005) Contemporary management of penile squamous cell carcinoma. J Surg Oncol 89:43–50PubMedCrossRefGoogle Scholar
  4. 4.
    Misra S, Chaturvedi A, Misra NC (2004) Penile carcinoma: a challenge for the developing world. Lancet Oncol 5:240–247PubMedCrossRefGoogle Scholar
  5. 5.
    Novara G, Galfano A, De Marco V, Artibani W, Ficarra V (2007) Prognostic factors in squamous cell carcinoma of the penis. Nat Clin Pract Urol 4:140–146PubMedCrossRefGoogle Scholar
  6. 6.
    Kroon BK, Horenblas S, Lont AP, Tanis PJ, Gallee MP, Nieweg OE (2005) Patients with penile carcinoma benefit from immediate resection of clinically occult lymph node metastases. J Urol 173:816–819PubMedCrossRefGoogle Scholar
  7. 7.
    Ficarra V, Galfano A (2007) Should the dynamic sentinel node biopsy (DSNB) be considered the gold standard in the evaluation of lymph node status in patients with penile carcinoma? Eur Urol 52:17–19 (discussion 20–11)PubMedCrossRefGoogle Scholar
  8. 8.
    Horenblas S (2001) Lymphadenectomy for squamous cell carcinoma of the penis. Part 2: the role and technique of lymph node dissection. BJU Int 88:473–483PubMedCrossRefGoogle Scholar
  9. 9.
    Busby JE, Pettaway CA (2005) What’s new in the management of penile cancer? Curr Opin Urol 15:350–357PubMedCrossRefGoogle Scholar
  10. 10.
    Ficarra V, Zattoni F, Cunico SC, Galetti TP, Luciani L, Fandella A, Guazzieri S, Maruzzi D, Sava T, Siracusano S, Pilloni S, Tasca A, Martignoni G, Gardiman M, Tardanico R, Zambolin T, Cisternino A, Artibani W (2005) Lymphatic and vascular embolizations are independent predictive variables of inguinal lymph node involvement in patients with squamous cell carcinoma of the penis: Gruppo Uro-Oncologico del Nord Est (Northeast Uro-Oncological Group) Penile Cancer data base data. Cancer 103:2507–2516PubMedCrossRefGoogle Scholar
  11. 11.
    Tobias-Machado M, Tavares A, Ornellas AA, Molina WR Jr, Juliano RV, Wroclawski ER (2007) Video endoscopic inguinal lymphadenectomy: a new minimally invasive procedure for radical management of inguinal nodes in patients with penile squamous cell carcinoma. J Urol 177:953–957 (discussion 958)PubMedCrossRefGoogle Scholar
  12. 12.
    Hegarty PK, Kayes O, Freeman A, Christopher N, Ralph DJ, Minhas S (2006) A prospective study of 100 cases of penile cancer managed according to European Association of Urology guidelines. BJU Int 98:526–531PubMedCrossRefGoogle Scholar
  13. 13.
    Solsona E, Iborra I, Ricos JV, Monros JL, Dumont R, Casanova J, Calabuig C (1992) Corpus cavernosum invasion and tumor grade in the prediction of lymph node condition in penile carcinoma. Eur Urol 22:115–118PubMedGoogle Scholar
  14. 14.
    Solsona E, Iborra I, Rubio J, Casanova JL, Ricos JV, Calabuig C (2001) Prospective validation of the association of local tumor stage and grade as a predictive factor for occult lymph node micrometastasis in patients with penile carcinoma and clinically negative inguinal lymph nodes. J Urol 165:1506–1509PubMedCrossRefGoogle Scholar
  15. 15.
    Solsona E, Algaba F, Horenblas S, Pizzocaro G, Windahl T (2004) EAU guidelines on penile cancer. Eur Urol 46:1–8PubMedCrossRefGoogle Scholar
  16. 16.
    Novara G, Artibani W, Cosciani Cunico S, De Giorgi G, Gardiman M, Martignoni G, Siracusano S, Tardanico R, Zattoni F, Ficarra V, and Members of the GUONE Penile Cancer Project (2008) How accurately Solsona and EAU risk groups predict the risk of lymph node metastases in patients with squamous cell carcinoma of the penis? Urology (in press)Google Scholar
  17. 17.
    Lopes A, Hidalgo GS, Kowalski LP, Torloni H, Rossi BM, Fonseca FP (1996) Prognostic factors in carcinoma of the penis: multivariate analysis of 145 patients treated with amputation and lymphadenectomy. J Urol 156:1637–1642PubMedCrossRefGoogle Scholar
  18. 18.
    Slaton JW, Morgenstern N, Levy DA, Santos MW Jr, Tamboli P, Ro JY, Ayala AG, Pettaway CA (2001) Tumor stage, vascular invasion and the percentage of poorly differentiated cancer: independent prognosticators for inguinal lymph node metastasis in penile squamous cancer. J Urol 165:1138–1142PubMedCrossRefGoogle Scholar
  19. 19.
    Lont AP, Kroon BK, Gallee MP, van Tinteren H, Moonen LM, Horenblas S (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 177:947–952 (discussion 952)PubMedCrossRefGoogle Scholar
  20. 20.
    Ficarra V, Zattoni F, Artibani W, Fandella A, Martignoni G, Novara G, Galetti TP, Zambolin T, Kattan MW (2006) Nomogram predictive of pathological inguinal lymph node involvement in patients with squamous cell carcinoma of the penis. J Urol 175:1700–1704 (discussion 1704–1705)PubMedCrossRefGoogle Scholar
  21. 21.
    Horenblas S, van Tinteren H (1994) Squamous cell carcinoma of the penis. IV. Prognostic factors of survival: analysis of tumor, nodes and metastasis classification system. J Urol 151:1239–1243PubMedGoogle Scholar
  22. 22.
    Horenblas S, van Tinteren H, Delemarre JF, Moonen LM, Lustig V, van Waardenburg EW (1993) Squamous cell carcinoma of the penis. III. Treatment of regional lymph nodes. J Urol 149:492–497PubMedGoogle Scholar
  23. 23.
    Pandey D, Mahajan V, Kannan RR (2006) Prognostic factors in node-positive carcinoma of the penis. J Surg Oncol 93:133–138PubMedCrossRefGoogle Scholar
  24. 24.
    Kattan MW, Ficarra V, Artibani W, Cunico SC, Fandella A, Martignoni G, Novara G, Galetti TP, Zattoni F (2006) Nomogram predictive of cancer specific survival in patients undergoing partial or total amputation for squamous cell carcinoma of the penis. J Urol 175:2103–2108 (discussion 2108)PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Vincenzo Ficarra
    • 1
    Email author
  • G. Novara
    • 2
  • R. Boscolo-Berto
    • 1
  • W. Artibani
    • 1
  • M. W. Kattan
    • 3
  1. 1.Department of Oncological and Surgical Sciences, Urology ClinicUniversity of PaduaPaduaItaly
  2. 2.I.R.C.C.S. Istituto Oncologico Veneto (I.O.V.)PaduaItaly
  3. 3.Department of Quantitative Health SciencesCleveland ClinicClevelandUSA

Personalised recommendations