Prognostic Factors



Identification and stratification of patients based on risk factors that predict for recurrence and progression of penile cancer are critical for patient and provider understanding of the disease as well as identification of appropriate therapy. Prognostic factors have primarily been studied in two clinical scenarios in penile cancer: (1) the identification of the patient with invasive primary cancer at high risk for developing inguinal lymph node metastases and (2) among those with inguinal lymph node metastases, predicting cancer-specific survival. Nomograms to predict for nodal metastases will allow the provider to carefully select patients for intervention on the lymph nodes while avoiding the potential side effect that such intervention may generate. Furthermore, a clear understanding of the factors which predict for survival will allow for optimal selection of patients for clinical trials.


Positive Lymph Node Lymphovascular Invasion Inguinal Lymph Node Penile Cancer Extracapsular Extension 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    AJCC. Penis. In: Edge SB, Byrd DR, Compton CC, et al., editors. AJCC cancer staging manual. 7th ed. New York: Springer; 2010. p. 447–55.Google Scholar
  2. 2.
    Fraley EE, Zhang G, Manivel C, Niehans GA. The role of ilioinguinal lymphadenectomy and significance of histological differentiation in treatment of carcinoma of the penis. J Urol. 1989;142(6):1478–82.PubMedGoogle Scholar
  3. 3.
    McDougal WS. Carcinoma of the penis: improved survival by early regional lymphadenectomy based on the histological grade and depth of invasion of the primary lesion. J Urol. 1995;154(4):1364–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Chaux A, Reuter V, Lezcano C, Velazquez EF, Torres J, Cubilla AL. Comparison of morphologic features and outcome of resected recurrent and nonrecurrent squamous cell carcinoma of the penis: a study of 81 cases. Am J Surg Pathol. 2009;33(9):1299–306.PubMedCrossRefGoogle Scholar
  5. 5.
    Chaux A, Torres J, Pfannl R, Barreto J, Rodriguez I, Velazquez EF, Cubilla AL. Histologic grade in penile squamous cell carcinoma: visual estimation versus digital measurement of proportions of grades, adverse prognosis with any proportion of grade 3 and correlation of a Gleason-like system with nodal metastasis. Am J Surg Pathol. 2009;33(7):1049–57.PubMedCrossRefGoogle Scholar
  6. 6.
    Lopes A, Hidalgo GS, Kowalski LP, Torloni H, Rossi BM, Fonseca FP. Prognostic factors in carcinoma of the penis: multivariate analysis of 145 patients treated with amputation and lymphadenectomy. J Urol. 1996;156(5):1637–42.PubMedCrossRefGoogle Scholar
  7. 7.
    Slaton JW, Morgenstern N, Levy DA, Santos Jr MW, Tamboli P, Ro JY, Ayala AG, Pettaway CA. Tumor stage, vascular invasion and the percentage of poorly differentiated cancer: independent prognosticators for inguinal lymph node metastasis in penile squamous cancer. J Urol. 2001;165(4):1138–42.PubMedCrossRefGoogle Scholar
  8. 8.
    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, Gruppo Uro-Oncologico del Nord Est (Northeast Uro-Oncological Group) Penile Cancer Project. 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. 2005;103(12):2507–16.PubMedCrossRefGoogle Scholar
  9. 9.
    Solsona E, Iborra I, Ricós JV, Monrós JL, Dumont R, Casanova J, Calabuig C. Corpus cavernosum invasion and tumor grade in the prediction of lymph node condition in penile carcinoma. Eur Urol. 1992;22(2):115–8.PubMedGoogle Scholar
  10. 10.
    Solsona E, Iborra I, Rubio J, Casanova JL, Ricós JV, Calabuig C. 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. 2001;165(5):1506–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Solsona E, Algaba F, Horenblas S, Pizzocaro G, Windahl T, European Association of Urology. EAU guidelines on penile cancer. Eur Urol. 2004;46(1):1–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Novara G, Artibani W, Cunico SC, De Giorgi G, Gardiman M, Martignoni G, Siracusano S, Tardanico R, Zattoni F, Ficarra V, GUONE Penile Cancer Project. How accurately do Solsona and European Association of Urology risk groups predict for risk of lymph node metastases in patients with squamous cell carcinoma of the penis? Urology. 2008;71(2):328–33.PubMedCrossRefGoogle Scholar
  13. 13.
    Ficarra V, Novara G, Boscolo-Berto R, Artibani W, Kattan MW. How accurate are present risk group assignment tools in penile cancer? World J Urol. 2009;27(2):155–60.PubMedCrossRefGoogle Scholar
  14. 14.
    Kattan MW. When and how to use informatics tools in caring for urologic patients. Nat Clin Pract Urol. 2005;2(4):183–90.PubMedCrossRefGoogle Scholar
  15. 15.
    Chaux A, Caballero C, Soares F, Guimarães GC, Cunha IW, Reuter V, Barreto J, Rodríguez I, Cubilla AL. The prognostic index: a useful pathologic guide for prediction of nodal metastases and survival in penile squamous cell carcinoma. Am J Surg Pathol. 2009;33(7):1049–57.PubMedCrossRefGoogle Scholar
  16. 16.
    Ficarra V, Zattoni F, Artibani W, Fandella A, Martignoni G, Novara G, Galetti TP, Zambolin T, Kattan MW, G.U.O.N.E. Penile Cancer Project Members. Nomogram predictive of pathological inguinal lymph node involvement in patients with squamous cell carcinoma of the penis. J Urol. 2006;175(5):1700–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Zhu Y, Zhang HL, Yao XD, Zhang SL, Dai B, Shen YJ, Ye DW. Development and evaluation of a nomogram to predict inguinal lymph node metastasis in patients with penile cancer and clinically negative lymph nodes. J Urol. 2010;184(2):539–45.PubMedCrossRefGoogle Scholar
  18. 18.
    Srinivas V, Morse MJ, Herr HW, Sogani PC, Whitmore Jr WF. Penile cancer: relation of extent of nodal metastasis to survival. J Urol. 1987;137(5):880–2.PubMedGoogle Scholar
  19. 19.
    Ornellas AA, Seixas AL, de Moraes JR. Analyses of 200 lymphadenectomies in patients with penile carcinoma. J Urol. 1991;146(2):330–2.PubMedGoogle Scholar
  20. 20.
    Pow-Sang JE, Benavente V, Pow-Sang JM, Pow-Sang M. Bilateral ilioinguinal lymph node dissection in the management of cancer of the penis. Semin Surg Oncol. 1990;6(4):241–2.PubMedCrossRefGoogle Scholar
  21. 21.
    Ravi R. Correlation between the extent of nodal involvement and survival following groin dissection for carcinoma of the penis. Br J Urol. 1993;72(5 Pt 2):817–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Kulkarni JN, Kamat MR. Prophylactic bilateral groin node dissection versus prophylactic radiotherapy and surveillance in patients with N0 and N1-2A carcinoma of the penis. Eur Urol. 1994;26(2):123–8.PubMedGoogle Scholar
  23. 23.
    Brkovic D, Kälble T, Dörsam J, Pomer S, Lötzerich C, Banafsche R, Riedasch G, Staehler G. Surgical treatment of invasive penile cancer–the Heidelberg experience from 1968 to 1994. Eur Urol. 1997;31(3):339–42.PubMedGoogle Scholar
  24. 24.
    Hegarty PK, Kayes O, Freeman A, Christopher N, Ralph DJ, Minhas S. A prospective study of 100 cases of penile cancer managed according to European Association of Urology guidelines. BJU Int. 2006;98(3):526–31.PubMedCrossRefGoogle Scholar
  25. 25.
    Novara G, Galfano A, De Marco V, Artibani W, Ficarra V. Prognostic factors in squamous cell carcinoma of the penis. Nat Clin Pract Urol. 2007;4(3):140–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Pandey D, Mahajan V, Kannan RR. Prognostic factors in node-positive carcinoma of the penis. J Surg Oncol. 2006;93(2):133–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Ornellas AA, Nóbrega BL, Wei Kin Chin E, Wisnescky A, da Silva PC, de Santos Schwindt AB. Prognostic factors in invasive squamous cell carcinoma of the penis: analysis of 196 patients treated at the Brazilian National Cancer Institute. J Urol. 2008;180(4):1354–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Zhu Y, Ye DW, Yao XD, Zhang SL, Dai B, Zhang HL. New N staging system of penile cancer provides a better reflection of prognosis. J Urol. 2011;186(2):518–23.PubMedCrossRefGoogle Scholar
  29. 29.
    Chaux A, Cubilla AL. Stratification systems as prognostic tools for defining risk of lymph node metastasis in penile squamous cell carcinomas. Semin Diagn Pathol. 2012;29(2):83.PubMedCrossRefGoogle Scholar
  30. 30.
    Svatek RS, Munsell M, Kincaid JM, et al. Association between lymph node density and disease specific survival in patients with penile cancer. J Urol. 2009;182:272.CrossRefGoogle Scholar
  31. 31.
    Zhu Y, Ye D-w. Lymph node metastases and prognosis in penile cancer. Chin J Cancer Res. 2012;24(2):90–6.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Leijte JA, Gallee M, Antonini N, Horenblas S. Evaluation of current TNM classification of penile carcinoma. J Urol. 2008;180(3):933–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Zhu Y, Zhang SL, Ye DW, et al. Predicting pelvic lymph node metastases in penile cancer patients: a comparison of computed tomography, Cloquet’s node, and disease burden of inguinal lymph nodes. Onkologie. 2008;31:37.PubMedCrossRefGoogle Scholar
  34. 34.
    Graafland NM, Moonen LM, van Boven HH, et al. Prognostic significance of extranodal extension in patients with pathological node positive penile carcinoma. J Urol. 2010;184:1347.PubMedCrossRefGoogle Scholar
  35. 35.
    Pagliaro LC, Williams DL, Daliani D, Williams MB, Osai W, Kincaid M, Wen S, Thall PF, Pettaway CA. Neoadjuvant paclitaxel, ifosfamide, and cisplatin chemotherapy for metastatic penile cancer: a phase II study. J Clin Oncol. 2010;28(24):3851–7.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Kattan MW, Ficarra V, Artibani W, Cunico SC, Fandella A, Martignoni G, Novara G, Galetti TP, Zattoni F, GUONE Penile Cancer Project Members. Nomogram predictive of cancer specific survival in patients undergoing partial or total amputation for squamous cell carcinoma of the penis. J Urol. 2006;175(6):2103–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Zini L, Cloutier V, Isbarn H, Perrotte P, Capitanio U, Jeldres C, Shariat SF, Saad F, Arjane P, Duclos A, Lattouf JB, Montorsi F, Karakiewicz PL. A simple and accurate model for prediction of cancer-specific mortality in patients treated with surgery for primary penile squamous cell carcinoma. Clin Cancer Res. 2009;15(3):1013–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Thuret R, Sun M, Abdollah F, Budaus L, Lughezzani G, Liberman D, Morgan M, Johal R, Jeldres C, Latour M, Shariat SF, Iborra F, Guiter J, Patard JJ, Perrotte P, Karakiewicz PI. Tumor grade improves the prognostic ability of American Joint Committee on Cancer stage in patients with penile carcinoma. J Urol. 2011;185(2):501–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Thuret R, Sun M, Abdollah F, Schmitges J, Shariat SF, Iborra F, Guiter J, Patard JJ, Perrotte P, Karakiewicz PI. Conditional survival predictions after surgery for patients with penile carcinoma. Cancer. 2011;117(16):3723–30.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of UrologyUniversity of Oklahoma Health Science CenterOklahoma CityUSA

Personalised recommendations