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Extent of pelvic lymph node dissection in penile cancer may impact survival

World Journal of Urology volume 34, pages 353–359 (2016)Cite this article

Abstract

Introduction

Current guidelines on management of penile carcinoma (PC) recommend ipsilateral pelvic lymph node dissection (PLND) in patients with inguinal lymph node metastasis (LNM) who meet specific criteria. The aim of this article was to assess outcomes in patients treated with bilateral PLND in the presence of unilateral metastatic pelvic nodes.

Methods

After IRB approval, four international centers contributed to this study. Men with PC and unilateral inguinal LNM and pelvic node metastases were retrospectively analyzed. Estimates of overall survival (OS) and cancer-specific survival were provided by the Kaplan–Meier method. Comparisons between subgroups were made using the log-rank test, and Cox regression analysis was used to adjust comparisons for covariates of interest.

Results

From 1978 to 2012, fifty-one men with unilateral inguinal LNM and positive pelvic nodes on PLND were identified. Thirty-eight (75 %) had ipsilateral and 13 (25 %) had bilateral PLND. Except the extent of the PLND, patients were comparable with respect to disease and therapeutic interventions. The Kaplan–Meier estimated median OS was significantly longer in the bilateral PLND patients (21.7 vs. 13.1, p = 0.051). On Cox regression analysis, bilateral PLND [HR 0.25, (95 % CI 0.10–0.64)], multiple pelvic node involvement [HR 2.12 (95 % CI 1.02–4.43)], neoadjuvant chemotherapy [HR 0.01, (95 % CI 0.02–0.44)] and adjuvant therapies [HR 0.16, (95 % CI 0.06–0.45)] (compared to no additional therapy) were independent predictors of OS.

Conclusions

Men with PC and pelvic node metastases may benefit from a bilateral PLND. This hypothesis requires further confirmation.

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Acknowledgments

The authors thank Mike Hernandez, Department of Biostatistics, The University of Texas, MD Anderson Cancer Center, for providing input in the statistical analysis.

Conflict of interest

None.

Ethical standard

IRB approval was obtained for use of patients’ data for the purpose of this study. All patients are informed at the time of surgical consent that their clinical data may be used for research purposes.

Author information

Affiliations

  1. Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Drive Office 12538, Tampa, FL, 33612, USA

    Kamran Zargar-Shoshtari, Pranav Sharma & Philippe E. Spiess

  2. Department of Urology, Netherlands Cancer Institute- Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    Rosa Djajadiningrat & Simon Horenblas

  3. Department of Urology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy

    Mario Catanzaro & Nicola Nicolai

  4. Fudan University Shanghai Cancer Center, Department of Urology, Shanghai, China

    Ding-Wei Ye & Yao Zhu

Authors
  1. Kamran Zargar-Shoshtari
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  2. Pranav Sharma
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  3. Rosa Djajadiningrat
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  4. Mario Catanzaro
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  5. Ding-Wei Ye
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  6. Yao Zhu
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  7. Nicola Nicolai
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  8. Simon Horenblas
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  9. Philippe E. Spiess
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Correspondence to Philippe E. Spiess.

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Zargar-Shoshtari, K., Sharma, P., Djajadiningrat, R. et al. Extent of pelvic lymph node dissection in penile cancer may impact survival. World J Urol 34, 353–359 (2016). https://doi.org/10.1007/s00345-015-1593-5

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  • DOI: https://doi.org/10.1007/s00345-015-1593-5

Keywords

  • Penile neoplasms
  • Lymph node excision
  • Algorithms