To identify incidence and risk factors for upstaging from cN1 to pN2/N3 at inguinal lymphadenectomy (ILND) for penile cancer (pSCC). Our secondary objective is to assess survival outcomes and associations for cN1 patients undergoing ILND.
Patients with pT≥1cN1cM0 pSCC who underwent bilateral ILND and had complete data were identified in a multi-institutional international cohort from 8 referral centers in 7 countries diagnosed from 1980 to 2017. Upstaging was defined as pN2/N3 at ILND. Multivariable logistic regression analysis was used to determine associations with upstaging, and Cox multivariable logistic regression analysis to determine associations with overall survival (OS).
Of 144 patients were included in the final study population. 84 patients (58%) were upstaged from cN1 to pN2/N3, and 25 (17%) were down staged to pN0. Upstaging was associated with pT3/T4 (OR 4.1, 95%CI 1.5-11.7, P < 0.01) and pTX (OR 7.1, 95CI 1.6-51.1, P = 0.02). Age, smoking status, HPV status, and LVI were not associated with upstaging. Age (HR 1.03/y, 95%CI 1.01-1.06, P < 0.01) and upstaging (HR 2.8, 95%CI 1.3-5.9, P < 0.01) were associated with worse OS. Upstaged patients had a 5-year OS of 49%, compared with 86% for patients who were not upstaged.
The majority of cN1 pSCC patients harbor a higher-risk disease state than their clinical staging suggests, especially those with higher pT stages. More intensive pre-operative workup may be warranted for these patients to identify upstaging prior to ILND and potentially qualify them for neoadjuvant chemotherapy or clinical trials.
Urologic oncology. 2021 Sep 30 [Epub ahead of print]
Nicholas H Chakiryan, Aaron Dahmen, Marco Bandini, Filippo Pederzoli, Laura Marandino, Maarten Albersen, Eduard Roussel, Yao Zhu, Ding-Wei Ye, Antonio A Ornellas, Mario Catanzaro, Oliver W Hakenberg, Axel Heidenreich, Friederike Haidl, Nick Watkin, Michael Ager, Alberto Briganti, Roberto Salvioni, Francesco Montorsi, Andrea Necchi, Philippe E Spiess
Department of Genitourinary Oncology, H Lee Moffitt Cancer Center, Tampa, FL., Department of Urology, University of South Florida, Tampa, FL. Electronic address: ., Unit of Urology, IRCCS Ospedale San Raffaele, Urological Research Institute (URI), Vita-Salute San Raffaele University, Milan, Italy., Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy., University Hospitals Leuven, Leuven, Belgium., Fudan University Shanghai Cancer Center, Shanghai, China., Hospital Mário Kröeff and Brazilian Cancer Institute, Rio de Janeiro, Brazil., University Hospital Rostock, Rostock, Germany., Universitätsklinikum Köln, Köln, Germany., St. George's University Hospitals, NHS Foundation Trust, London, UK.