Abstract
Purpose
To identify factors predicting the risk of inguinal metastasis in squamous cell carcinoma of the penis. The therapeutic advantages of early lymphadenectomy in squamous cell carcinoma of the penis must be counterbalanced against its post-operative morbidity. Loss to follow up is a major problem in developing countries. Generating a nomogram based on clinical lymph node status and histopathological findings in the primary tumor could facilitate clinical decision making in the management of penile cancer.
Methods
We prospectively studied 106 patients with penile squamous cell cancer treated from September 2001 to August 2007 at our institution. All patients were offered lymphadenectomy (LAD). A multivariate logistic regression model was used to develop a nomogram. We highlight the problems of loss to follow up in these patients.
Results
Of 53 who opted for LAD, 22 had nodal metastasis. The presence of high grade (P = 0.004), lymphovascular invasion (LVI) (P = 0.01) and palpable inguinal lymph nodes (P = 0.05) were the strongest predictors of metastasis. Of 51 who refused LAD, 22 were lost to follow up. Out of these, 16 were at high risk and 9 of them came back with inoperable fungating nodes. A nomogram predicting the risk of lymph node metastasis showed a bias corrected good concordance index (0.74) and good calibration.
Conclusions
High grade and LVI in the tumor along with clinical stage of the inguinal nodes were the strongest predictors of metastasis. These features helped us to develop a nomogram to predict and to identify patients at risk of nodal metastasis.
Similar content being viewed by others
References
Srinivas V, Morse MJ, Herr HW, Sogani PC, Whitmore WF Jr (1987) Penile cancer: relation of extent of nodal metastasis to survival. J Urol 137:880
Ornellas AA, Sexias AL, Marota A, Wisnescky A, Campos F, de Moraes JR (1994) Surgical treatment invasive squamous cell carcinoma of the penis: retrospective analysis of 350 cases. J Urol 151(5):1244–1249
Abi-Aad AS, Dekernion JB (1992) Controversies in ilioinguinal lymphadenectomy for cancer of penis. Urol Clin North Am 19:319
Horenblas S, van Tinteren H, Delemane JF et al (1993) Squamous cell carcinoma of the penis. Treatment of regional nodes. J Urol 149:492
Beggs JH, Spratt JS (1964) Epidermoid carcinoma of the penis. J Urol 91:166
Theodorescu D, Russo P, Zang ZF, Morash C, Fair WR (1996) Outcome of initial surveillance of invasive squamous cell carcinoma of the penis and negative nodes. J Urol 155:1626–1631. doi:10.1016/S0022-5347(01)66147-0
Hardner GJ, Bhanalaph T, Murphy GP et al (1972) Carcinoma of the penis; analysis of therapy in 100 consecutive cases. J Urol 108:428
Hughes B, Leijte J, Shabbir M, Watkin N, Horenblas S (2009) Non-invasive and minimally invasive staging of regional lymph nodes in penile cancer. World J Urol 27:197–203. doi:10.1007/s00345-008-0288-6
Horenblas S (2001) Lymphadenectomy for squamous cell carcinoma of the penis. Part 2: the role and technique of lymph node dissection. BJU Int 88:473–483. doi:10.1046/j.1464-410X.2001.00379.x
Hungerhuber E, Schlenker B, Frimberger D et al (2006) Lymphoscintigraphy in penile cancer: limited value of sentinel node biopsy in patients with clinically suspicious lymph nodes. World J Urol 24(3):319–324. doi:10.1007/s00345-006-0073-3
Lont AP, Horenblas S, Gallee MPW, van Tinteren H, Nieweg OE (2003) Management of clinically node negative penile carcinoma; improved survival after introduction of dynamic sentinel node biopsy. J Urol 170:783. doi:10.1097/01.ju.0000081201.40365.75
Murphy GF, Elder DE. Non-melanocytic tumors of the skin. Atlas of tumor pathology, vol 1, 3rd edn. Armed Forces Institute of Pathology 1991, Washington DC
Harrell FE Jr (2001) Regression modeling strategies with applications to linear models, logistic regression, and survival analysis. Springer, New York
Ficarra V, Zattoni F, Artibani W, Fandella A, Martignoni G, Novara G et al (2006) Nomogram predictive of pathological inguinal lymphnode involvement inpatients with squamous cell carcinoma of the penis. J Urol 175:1700–1705. doi:10.1016/S0022-5347(05)01003-7
Solosona E, Algaba F, Horenblas S, Pizzocaro G, Windahl T, European Association of Urology (2004) EAU Guidelines on Penile Cancer. Eur Urol 46:1. doi:10.1016/j.eururo.2004.03.007
McDougal WS (1995) Carcinoma of the penis; improved survival by early regional lymphadenectomy based on histological grade and depth of invasion of the primary lesion. J Urol 154:1364. doi:10.1016/S0022-5347(01)66863-0
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 156:1637–1642. doi:10.1016/S0022-5347(01)65471-5
Slaton JW, Morgenstern N, Levy DA et al (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 165:1138–1142. doi:10.1016/S0022-5347(05)66450-6
Emerson RE, Ulbright TM, Eble JN, Geavy WA, Eckert GJ, Cheng L (2001) Predicting cancer progression in patients with penile squamous cell carcinoma: the importance of depth of invasion and vascular invasion. Mod Pathol 14:963–968. doi:10.1038/modpathol.3880419
Conflict of interest statement
There is no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bhagat, S.K., Gopalakrishnan, G., Kekre, N.S. et al. Factors predicting inguinal node metastasis in squamous cell cancer of penis. World J Urol 28, 93–98 (2010). https://doi.org/10.1007/s00345-009-0421-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-009-0421-1