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Effect of inguinal lymph node dissection in lymph node negative patients with squamous cell carcinoma of the penis

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Abstract

Introduction

The survival benefit of inguinal lymph node dissection (ILND) vs no ILND in patients with squamous cell carcinoma of the penis (SCCP) and the absence of lymph node invasion is unclear. We addressed this uncertainty within the Surveillance, Epidemiology and End Results (SEER 2000–2018) database.

Material and methods

We identified lymph node negative SCCP patients who either underwent ILND (pN0) or clinical examination only (cN0). We tested for the effect of ILND vs no ILND on cancer-specific mortality (CSM) in Kaplan–Meier plots, univariable and multivariable Cox regression analyses, in a pT stage-specific fashion, before and after 1:3 propensity score matching (PSM). Sensitivity analyses were conducted according to historical and contemporary treatment periods as well as geographic regions.

Results

Of 2520 SCCP patients, 369 (15%) underwent ILND (pN0) vs 2151 (85%) did not (cN0). The pN0 vs cN0 distribution according to pT stages was as follows: 80 (7%) vs 1092 (93%) in pT1b, and 289 (21%) vs 1059 (79%) in pT2-3. At 36 months, CSM-free survival in pT2-3 stage was 89% in ILND vs 74% in no ILND patients (multivariable hazard ratio: 0.42, CI 0.30–0.60, p < 0.001). This result was confirmed in sensitivity analyses, and after 1:3 PSM. The same analyses could not be completed in pT1b stage due to insufficient number of observations and events.

Conclusions

In pT2-3 stage SCCP, a significantly lower CSM was recorded in lymph node negative patients treated with ILND than in their clinical lymph node negative counterparts who did not undergo ILND.

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Data availability statement

All data generated for this analysis were from the Surveillance, Epidemiology, and End Results Research Plus (SEER) database. The code for the analyses will be made available upon request.

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Acknowledgements

The authors have no acknowledgments.

Funding

The research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Author information

Authors and Affiliations

  1. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada

    Stefano Tappero, Mattia Piccinelli, Francesco Barletta, Andrea Panunzio, Cristina Cano Garcia, Reha-Baris Incesu, Zhe Tian, Fred Saad & Pierre I. Karakiewicz

  2. Department of Urology, IRCCS Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy

    Stefano Tappero, Stefano Parodi, Marco Borghesi & Carlo Terrone

  3. Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genoa, Italy

    Stefano Tappero, Stefano Parodi, Marco Borghesi & Carlo Terrone

  4. Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy

    Mattia Piccinelli & Ottavio De Cobelli

  5. Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Francesco Barletta & Alberto Briganti

  6. Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy

    Andrea Panunzio & Alessandro Antonelli

  7. Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany

    Cristina Cano Garcia & Felix K. H. Chun

  8. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Reha-Baris Incesu & Markus Graefen

  9. Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Paolo Dell’Oglio

  10. Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    Paolo Dell’Oglio

  11. Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands

    Paolo Dell’Oglio

  12. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria

    Shahrokh F. Shariat

  13. Department of Urology, Weill Cornell Medical College, New York, NY, USA

    Shahrokh F. Shariat

  14. Department of Urology, University of Texas Southwestern, Dallas, TX, USA

    Shahrokh F. Shariat

  15. Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan

    Shahrokh F. Shariat

  16. Department of Urology, Spedali Civili of Brescia, Brescia, Italy

    Nazareno R. Suardi

Authors
  1. Stefano Tappero
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  2. Mattia Piccinelli
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  3. Francesco Barletta
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  4. Andrea Panunzio
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  5. Cristina Cano Garcia
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  6. Reha-Baris Incesu
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  7. Zhe Tian
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  8. Stefano Parodi
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  10. Ottavio De Cobelli
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  11. Alberto Briganti
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  13. Felix K. H. Chun
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  14. Markus Graefen
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  15. Fred Saad
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  18. Marco Borghesi
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  19. Carlo Terrone
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  20. Pierre I. Karakiewicz
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Contributions

ST concept and design; draft of manuscript; statistical analysis; analysis and interpretation of the data. MP acquisition of data; analysis and interpretation of the data; statistical analysis. FB acquisition of data; analysis and interpretation of the data; statistical analysis. AP acquisition of data; analysis and interpretation of the data; statistical analysis. CCG acquisition of data; analysis and interpretation of the data. R-BI statistical analysis; analysis and interpretation of the data. ZT acquisition of data; statistical analysis. SP analysis and interpretation of the data. PDO critical revision of the manuscript; important intellectual content. ODC critical revision of the manuscript; important intellectual content. AB supervision; critical revision of the manuscript; important intellectual content. AA supervision; critical revision of the manuscript; important intellectual content. FKHC critical revision of the manuscript; important intellectual content. MG critical revision of the manuscript; important intellectual content. FS critical revision of the manuscript; important intellectual content. SFS critical revision of the manuscript; important intellectual content. NRS critical revision of the manuscript; supervision; important intellectual content. MB critical revision of the manuscript; important intellectual content. CT concept and design; supervision; critical revision of the manuscript; important intellectual content. PIK concept and design; acquisition of data; draft of manuscript; statistical analysis; supervision; critical revision of the manuscript; important intellectual content.

Corresponding author

Correspondence to Stefano Tappero.

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Ethics consent statement

All analyses and their reporting followed the SEER reporting guidelines. Due to the anonymously coded design of the SEER database, study-specific Institutional Review Board ethics approval was not required.

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Tappero, S., Piccinelli, M., Barletta, F. et al. Effect of inguinal lymph node dissection in lymph node negative patients with squamous cell carcinoma of the penis. World J Urol 41, 119–125 (2023). https://doi.org/10.1007/s00345-022-04184-z

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  • DOI: https://doi.org/10.1007/s00345-022-04184-z

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